Provider Demographics
NPI:1609019108
Name:PHAM, CINDY DANG (MPT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:DANG
Last Name:PHAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:VI
Other - Middle Name:DANG
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12851 HASTER ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6559
Mailing Address - Country:US
Mailing Address - Phone:314-600-0912
Mailing Address - Fax:
Practice Address - Street 1:8787 CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3034
Practice Address - Country:US
Practice Address - Phone:619-460-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist