Provider Demographics
NPI:1710557970
Name:KHUONG, THAI THANH (DPT)
Entity Type:Individual
Prefix:DR
First Name:THAI
Middle Name:THANH
Last Name:KHUONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD STE 40
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4100
Mailing Address - Country:US
Mailing Address - Phone:678-257-4037
Mailing Address - Fax:678-819-7536
Practice Address - Street 1:1670 MCKENDREE CHURCH RD STE 40
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4100
Practice Address - Country:US
Practice Address - Phone:678-257-4037
Practice Address - Fax:678-819-7536
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist