Provider Demographics
NPI:1003532102
Name:NGUYEN, PHONG TUAN JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:TUAN JOSEPH
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 1:17355 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4400
Mailing Address - Country:US
Mailing Address - Phone:408-706-6784
Mailing Address - Fax:
Practice Address - Street 1:1395 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3876
Practice Address - Country:US
Practice Address - Phone:408-703-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist