Provider Demographics
NPI:1730669904
Name:HOANG, BERNADINE MALQUED (DPT)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:MALQUED
Last Name:HOANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 N 25TH ST APT 418
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5322
Mailing Address - Country:US
Mailing Address - Phone:909-222-7933
Mailing Address - Fax:
Practice Address - Street 1:5701 N 26TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2408
Practice Address - Country:US
Practice Address - Phone:253-507-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295274225100000X
WA60928946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist