Individual ProviderBrian William WongPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2492 Walnut Ave Ste 140, Tustin, CA 92780-6953(714) 544-2188PECOS EnrollmentBased on the most recent information from CMS, provider Brian William Wong does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1255534418Provider TypeIndividualFull NameWong, Brian WilliamCredentialPTGenderMaleSole ProprietorNoEnumeration Date6/6/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address2492 Walnut Ave Ste 140, Tustin, CA 92780-6953Phone(714) 544-2188FaxUnlisted FaxMailing LocationMailing Address2492 Walnut Ave Ste 140, Tustin, CA 92780-6953Phone(714) 544-2188FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT13998CaliforniaCode2251S0007XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT13998CaliforniaCode2251X0800XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT13998CaliforniaProvider IdentifiersIDDescriptionIssuerIDPT13998DescriptionOtherIssuerPT LICENSE#California