Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 42831 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1290020 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 42831 | CA |
NPI | 1013372283 |
---|---|
Provider Name | Jacqueline Dang Truong |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Live Oak, TX 78233-3277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2015 |
Last Update Date | 29/03/2020 |