Provider Demographics
NPI:1114433307
Name:TON, QUANG THAT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:THAT
Last Name:TON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43183 THISTLEDOWN TER APT 333
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4079
Mailing Address - Country:US
Mailing Address - Phone:402-904-1171
Mailing Address - Fax:
Practice Address - Street 1:540 FORT EVANS RD STE 206
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3379
Practice Address - Country:US
Practice Address - Phone:703-777-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-25
Last Update Date:2017-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist