Provider Demographics
NPI:1841568060
Name:TA, MY CHUONG (BS, PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:MY
Middle Name:CHUONG
Last Name:TA
Suffix:
Gender:F
Credentials:BS, PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SW 122ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4855
Mailing Address - Country:US
Mailing Address - Phone:405-620-6413
Mailing Address - Fax:405-752-3191
Practice Address - Street 1:3328 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3428
Practice Address - Country:US
Practice Address - Phone:405-524-5200
Practice Address - Fax:405-524-5206
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist