Provider Demographics
NPI:1598912198
Name:TAN, VIRGINIA FUI PHING (PT)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:FUI PHING
Last Name:TAN
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 1:6440 SOUTH MILROCK DR
Mailing Address - Street 2:STE 175
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3600
Mailing Address - Country:US
Mailing Address - Phone:866-724-8555
Mailing Address - Fax:866-588-1518
Practice Address - Street 1:6440 SOUTH MILROCK DR
Practice Address - Street 2:STE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3600
Practice Address - Country:US
Practice Address - Phone:866-724-8555
Practice Address - Fax:866-588-1518
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004755A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist