Provider Demographics
NPI:1265919518
Name:VANG, NOU (DPT)
Entity type:Individual
Prefix:MS
First Name:NOU
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 JESSAMINE AVE W APT 205
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2634
Mailing Address - Country:US
Mailing Address - Phone:715-450-5293
Mailing Address - Fax:
Practice Address - Street 1:3401 E MEDICINE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2307
Practice Address - Country:US
Practice Address - Phone:763-559-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist