Provider Demographics
NPI:1245514926
Name:CHUNG, VINH QUOC (DPT)
Entity type:Individual
Prefix:
First Name:VINH
Middle Name:QUOC
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 6TH AVE SE STE 203
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1042
Mailing Address - Country:US
Mailing Address - Phone:360-455-4448
Mailing Address - Fax:360-455-9833
Practice Address - Street 1:2964 LIMITED LN NW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4577
Practice Address - Country:US
Practice Address - Phone:360-704-7276
Practice Address - Fax:360-704-7277
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60220972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist