Provider Demographics
NPI:1285192211
Name:DUONG, THOMAS THOI CHAU (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS THOI
Middle Name:CHAU
Last Name:DUONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 LAWREN LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1556
Mailing Address - Country:US
Mailing Address - Phone:909-254-7399
Mailing Address - Fax:
Practice Address - Street 1:6865 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3739
Practice Address - Country:US
Practice Address - Phone:949-679-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist