Provider Demographics
NPI:1033377486
Name:PHAN, HAI-DUONG T (PT)
Entity Type:Individual
Prefix:MRS
First Name:HAI-DUONG
Middle Name:T
Last Name:PHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HAI-DI
Other - Middle Name:T
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:113 CONNER GRANT RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 FOXHALL RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6790
Practice Address - Country:US
Practice Address - Phone:252-223-2560
Practice Address - Fax:252-223-6955
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist