Active NPI
CHI Wan Wong, PTA
- Physical Therapy Assistant
- Holyoke, MA
National Provider Identifier
1184097768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 8698
- Practice address
- 110 Cherry Street
Holyoke, MA 01040 - Phone
- (413) 538-4184
- Fax
- (413) 538-4183
- NPI assigned
- Nov 4, 2015
- Reactivated
- Dec 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 8698 | MA | Primary |
Addresses
Primary practice location
110 Cherry Street
Holyoke, MA 01040
Mailing address
110 Cherry Street
Holyoke, MA 01040
Phone (413) 538-4184
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8698 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545350400000",
"number": "1184097768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 CHERRY STREET",
"city": "HOLYOKE",
"state": "MA",
"postal_code": "01040",
"telephone_number": "413-538-4184",
"fax_number": "413-538-4183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CHERRY STREET",
"city": "HOLYOKE",
"state": "MA",
"postal_code": "01040",
"telephone_number": "413-538-4184",
"fax_number": "413-538-4183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "CHI WAN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-04",
"last_updated": "2018-12-21",
"deactivation_date": "2018-10-03",
"reactivation_date": "2018-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "8698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holyoke, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.