Provider Demographics
NPI:1225798853
Name:VUTRAN, VINCENT HIEU (DPT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:HIEU
Last Name:VUTRAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:
Practice Address - Street 1:77622 COUNTRY CLUB DR STE G
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0447
Practice Address - Country:US
Practice Address - Phone:760-345-3087
Practice Address - Fax:760-345-6852
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist