Provider Demographics
NPI:1942785365
Name:PHAM, FRANK QUOC (PTA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:QUOC
Last Name:PHAM
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 1:5107 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2517
Mailing Address - Country:US
Mailing Address - Phone:816-529-6537
Mailing Address - Fax:
Practice Address - Street 1:5107 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2517
Practice Address - Country:US
Practice Address - Phone:816-529-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018034752208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation