Provider Demographics
NPI:1316779382
Name:WOO, DAVE SHERWIN WONG
Entity type:Individual
Prefix:
First Name:DAVE SHERWIN
Middle Name:WONG
Last Name:WOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 PEACHTREE RD APT E
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2233
Mailing Address - Country:US
Mailing Address - Phone:302-803-2808
Mailing Address - Fax:
Practice Address - Street 1:3322 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3307
Practice Address - Country:US
Practice Address - Phone:302-478-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist