Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1189431 | TX |
NPI | 1003135732 |
---|---|
Provider Name | Dr. Phong The Nguyen |
First Address | Cypress, TX 77429-5276 |
Second Address | Cypress, TX 77429-5276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2010 |
Last Update Date | 20/05/2010 |