Provider Demographics
NPI:1003135732
Name:NGUYEN, PHONG THE (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHONG
Middle Name:THE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 DUNOON BAY POINT CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5276
Mailing Address - Country:US
Mailing Address - Phone:225-284-7489
Mailing Address - Fax:
Practice Address - Street 1:18002 DUNOON BAY POINT CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5276
Practice Address - Country:US
Practice Address - Phone:225-284-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist