Provider Demographics
NPI:1821246174
Name:HA, DIEM PHUONG (DPT)
Entity Type:Individual
Prefix:DR
First Name:DIEM
Middle Name:PHUONG
Last Name:HA
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 1:28 ATLANTIC AVE
Mailing Address - Street 2:125 LEWIS WHARF
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110
Mailing Address - Country:US
Mailing Address - Phone:617-523-2766
Mailing Address - Fax:
Practice Address - Street 1:28 ATLANTIC AVE
Practice Address - Street 2:125 LEWIS WHARF
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3802
Practice Address - Country:US
Practice Address - Phone:617-523-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist