Provider Demographics
NPI:1689225930
Name:THACH, PHUONG THAI (NMD, AP, DIPL OM)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:THAI
Last Name:THACH
Suffix:
Gender:F
Credentials:NMD, AP, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10775 CREEK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-8217
Mailing Address - Country:US
Mailing Address - Phone:850-304-7881
Mailing Address - Fax:
Practice Address - Street 1:7700 US-98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506
Practice Address - Country:US
Practice Address - Phone:425-333-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X, 175F00000X
FL4359171100000X
WANT60999770175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty