Provider Demographics
NPI:1033893524
Name:HA, HUAN NGUYEN (PTA)
Entity Type:Individual
Prefix:
First Name:HUAN
Middle Name:NGUYEN
Last Name:HA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 FOUNTAIN LAKES CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4782
Mailing Address - Country:US
Mailing Address - Phone:402-613-0772
Mailing Address - Fax:
Practice Address - Street 1:5270 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-6510
Practice Address - Country:US
Practice Address - Phone:470-482-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1469225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant