Basic Information
| Provider Information | |||||||||
| NPI: | 1154769859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | HICUM | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | CHONG | ||||||||
| OtherFirstName: | HICUM | ||||||||
| OtherMiddleName: | ANGELICA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1600 STAINBACK RD | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751543008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149738425 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 STAINBACK RD | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751543008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149738425 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1235910 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.