Provider Demographics
NPI:1407088602
Name:LUONG, SAMANTHA VINH (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:VINH
Last Name:LUONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:SAM
Other - Middle Name:A
Other - Last Name:LUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2129 KEITH STREET, APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2129 KEITH STREET, APT B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3130
Practice Address - Country:US
Practice Address - Phone:323-225-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist