Provider Demographics
NPI:1477784957
Name:LE, PHUONG (OT)
Entity Type:Individual
Prefix:MR
First Name:PHUONG
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E PIKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5038
Mailing Address - Country:US
Mailing Address - Phone:956-968-1159
Mailing Address - Fax:956-968-0315
Practice Address - Street 1:1501 E PIKE BLVD
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5038
Practice Address - Country:US
Practice Address - Phone:956-968-1159
Practice Address - Fax:956-968-0315
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist