Provider Demographics
NPI:1568590883
Name:PHAN, ELIZABETH THUY (MSPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THUY
Last Name:PHAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1536
Mailing Address - Country:US
Mailing Address - Phone:732-541-2233
Mailing Address - Fax:732-541-2234
Practice Address - Street 1:1175 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1536
Practice Address - Country:US
Practice Address - Phone:732-541-2233
Practice Address - Fax:732-541-2234
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01041100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083165Medicare PIN