Provider Demographics
NPI:1184723843
Name:THAI, LINH C (PT)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:C
Last Name:THAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:475 PIONEER AVE
Practice Address - Street 2:#200
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4905
Practice Address - Country:US
Practice Address - Phone:530-406-5620
Practice Address - Fax:530-406-5622
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0285200Medicaid
Q59051Medicare UPIN
CAPT0285200Medicaid