Provider Demographics
NPI:1750143517
Name:LAU, EDWARD MANKWONG (DPT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:MANKWONG
Last Name:LAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S FAIR OAKS AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4123
Mailing Address - Country:US
Mailing Address - Phone:626-585-1345
Mailing Address - Fax:
Practice Address - Street 1:257 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4130
Practice Address - Country:US
Practice Address - Phone:626-585-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT305345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist