Provider Demographics
NPI:1659582831
Name:DONOVAN, TRANG VU (LMT)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:VU
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2938
Mailing Address - Country:US
Mailing Address - Phone:773-704-3647
Mailing Address - Fax:773-276-1760
Practice Address - Street 1:3354 N PAULINA ST
Practice Address - Street 2:STUDIO 206C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1068
Practice Address - Country:US
Practice Address - Phone:773-704-3647
Practice Address - Fax:773-276-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist