Provider Demographics
NPI:1740614452
Name:TRUONG, LIANE N (DPT)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:N
Last Name:TRUONG
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 1:2988 S CASCADE WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2351
Mailing Address - Country:US
Mailing Address - Phone:808-385-0576
Mailing Address - Fax:
Practice Address - Street 1:174 W PARRISH LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1821
Practice Address - Country:US
Practice Address - Phone:801-298-7330
Practice Address - Fax:801-295-5434
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8705248-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist