Provider Demographics
NPI:1114495850
Name:LUONG, KEVIN VAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:VAN
Last Name:LUONG
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 1:1712 STUMPF BLVD
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3923
Mailing Address - Country:US
Mailing Address - Phone:504-365-1020
Mailing Address - Fax:504-365-1080
Practice Address - Street 1:1712 STUMPF BLVD
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3923
Practice Address - Country:US
Practice Address - Phone:504-365-1020
Practice Address - Fax:504-365-1080
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9205225100000X
LA11442R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist