Provider Demographics
NPI:1508043308
Name:THANG, VIDA
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:THANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIDA
Other - Middle Name:THANG
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:68 ALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-6958
Mailing Address - Country:US
Mailing Address - Phone:508-880-0202
Mailing Address - Fax:
Practice Address - Street 1:68 ALLISON AVE
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-6958
Practice Address - Country:US
Practice Address - Phone:508-880-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH-5650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist