Provider Demographics
NPI:1861205064
Name:PADLAN, MARK ONG (PTA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ONG
Last Name:PADLAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 HUNNINGDON WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8219
Mailing Address - Country:US
Mailing Address - Phone:757-895-9113
Mailing Address - Fax:
Practice Address - Street 1:1428 HUNNINGDON WOODS BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8219
Practice Address - Country:US
Practice Address - Phone:757-895-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant