Provider Demographics
NPI:1659898542
Name:TRINH, YVAN THI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:YVAN
Middle Name:THI
Last Name:TRINH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 SW VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3039
Mailing Address - Country:US
Mailing Address - Phone:503-888-6353
Mailing Address - Fax:503-926-6397
Practice Address - Street 1:16303 NE 15TH ST
Practice Address - Street 2:STE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4189
Practice Address - Country:US
Practice Address - Phone:503-888-6353
Practice Address - Fax:503-926-6397
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2155632Medicaid