Provider Demographics
NPI:1184682965
Name:TRAN, THAO (PT)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1415
Mailing Address - Country:US
Mailing Address - Phone:609-892-4584
Mailing Address - Fax:855-633-3786
Practice Address - Street 1:918 SOUTH AVE W STE 1
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1415
Practice Address - Country:US
Practice Address - Phone:855-633-3786
Practice Address - Fax:855-633-3786
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01105400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist