Provider Demographics
NPI:1154846061
Name:LE, VAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5807 MCKINLEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4900
Mailing Address - Country:US
Mailing Address - Phone:214-457-6002
Mailing Address - Fax:
Practice Address - Street 1:5807 MCKINLEY LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4900
Practice Address - Country:US
Practice Address - Phone:214-457-6002
Practice Address - Fax:214-457-6002
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1196438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist