Provider Demographics
NPI:1205558657
Name:NGUYEN, AN TRUONG (PT)
Entity type:Individual
Prefix:DR
First Name:AN
Middle Name:TRUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 VARNER CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-3039
Mailing Address - Country:US
Mailing Address - Phone:925-719-3538
Mailing Address - Fax:
Practice Address - Street 1:3468 VARNER CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-3039
Practice Address - Country:US
Practice Address - Phone:925-719-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist