Provider Demographics
NPI:1477769354
Name:NGUYEN, KIMPHUONG THI (PT)
Entity Type:Individual
Prefix:MISS
First Name:KIMPHUONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 CORONET DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4504
Mailing Address - Country:US
Mailing Address - Phone:504-491-1249
Mailing Address - Fax:
Practice Address - Street 1:7601 CORONET DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4504
Practice Address - Country:US
Practice Address - Phone:504-491-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist