Provider Demographics
NPI:1861815219
Name:PHAN, BINH (PTA)
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868 S IVY ST APT 108
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6264
Mailing Address - Country:US
Mailing Address - Phone:714-642-7363
Mailing Address - Fax:
Practice Address - Street 1:6868 S IVY ST APT 108
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6264
Practice Address - Country:US
Practice Address - Phone:714-642-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant