Provider Demographics
NPI:1760061394
Name:NGUYEN, PHUONG DINH (COTA)
Entity Type:Individual
Prefix:MR
First Name:PHUONG
Middle Name:DINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 HYLAND PARK
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2866
Mailing Address - Country:US
Mailing Address - Phone:832-212-3759
Mailing Address - Fax:
Practice Address - Street 1:4606 FARM TO MARKET 1960 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-7701
Practice Address - Country:US
Practice Address - Phone:346-333-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216626225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty