Provider Demographics
NPI:1013631373
Name:NGUYEN, JITPISOT JUMNONGJIT
Entity Type:Individual
Prefix:
First Name:JITPISOT
Middle Name:JUMNONGJIT
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N GREENVILLE AVE APT 44
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2274
Mailing Address - Country:US
Mailing Address - Phone:240-383-5542
Mailing Address - Fax:
Practice Address - Street 1:931 W BETHANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3739
Practice Address - Country:US
Practice Address - Phone:972-449-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist