Provider Demographics
NPI:1275221392
Name:PHAM, CUONG NGUYEN
Entity Type:Individual
Prefix:MR
First Name:CUONG
Middle Name:NGUYEN
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 MULBERRY LN UNIT F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5744
Mailing Address - Country:US
Mailing Address - Phone:252-564-2398
Mailing Address - Fax:
Practice Address - Street 1:2932 MULBERRY LN UNIT F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5744
Practice Address - Country:US
Practice Address - Phone:252-564-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8051225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant