Provider Demographics
NPI:1922166800
Name:NGUYEN, THERESA T (MPT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:T
Other - Last Name:EGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:27141 HIDAWAY AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4131
Mailing Address - Country:US
Mailing Address - Phone:661-424-9333
Mailing Address - Fax:661-424-9463
Practice Address - Street 1:27141 HIDAWAY AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-4131
Practice Address - Country:US
Practice Address - Phone:661-424-9333
Practice Address - Fax:661-424-9463
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP64357Medicare UPIN
CAPT24356Medicare PIN