Provider Demographics
NPI:1871326702
Name:PANG, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1813
Practice Address - Country:US
Practice Address - Phone:978-524-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist