Provider Demographics
NPI:1275202046
Name:NGHIEM, GABRIELLE HAN QUYNH NANG (PT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE HAN
Middle Name:QUYNH NANG
Last Name:NGHIEM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-830-6360
Mailing Address - Fax:703-830-6362
Practice Address - Street 1:5900 FORT DR STE 208
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2425
Practice Address - Country:US
Practice Address - Phone:703-830-6360
Practice Address - Fax:703-830-6362
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305214690208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation