Active NPI
Man Wai Alice Wong, DPT, CLT
- Physical Therapist
- Southgate, MI
National Provider Identifier
1629578182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501015872
- Practice address
- 15777 Northline Rd Ste 102
Southgate, MI 48195-2300 - Phone
- (734) 246-8125
- Fax
- (734) 246-8113
- NPI assigned
- Feb 20, 2018
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 5501015872 | MI | Primary |
Addresses
Primary practice location
15777 Northline Rd Ste 102
Southgate, MI 48195-2300
Mailing address
43538 Bannockburn Dr
Canton, MI 48187-2820
Phone (248) 787-8185
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 |
|---|---|---|---|
| 5501015872 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakwood Healthcare Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Corewell Health Retail Pharmacy Westland
- Community/Retail Pharmacy
- Westland, MI
- NPI 1033128178
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519084800000",
"number": "1629578182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43538 BANNOCKBURN DR",
"city": "CANTON",
"state": "MI",
"postal_code": "481872820",
"telephone_number": "248-787-8185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15777 NORTHLINE RD STE 102",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952300",
"telephone_number": "734-246-8125",
"fax_number": "734-246-8113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "MAN WAI",
"middle_name": "ALICE",
"credential": "DPT, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-20",
"last_updated": "2018-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501015872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.