Provider Demographics
NPI:1730620543
Name:VONG, JOSHUA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:VONG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHYH-CHANG
Other - Middle Name:JOSHUA
Other - Last Name:VONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2718 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5372
Mailing Address - Country:US
Mailing Address - Phone:310-383-3472
Mailing Address - Fax:
Practice Address - Street 1:3107 W. CAMP WISDOM ROAD SUITE 131
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:214-339-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12876892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic