Provider Demographics
NPI:1649645227
Name:LUU, THAO-TIEN NGOC (DPT)
Entity type:Individual
Prefix:
First Name:THAO-TIEN
Middle Name:NGOC
Last Name:LUU
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 1:1665 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4846
Mailing Address - Country:US
Mailing Address - Phone:315-327-5737
Mailing Address - Fax:
Practice Address - Street 1:26 CONKEY AVE
Practice Address - Street 2:SECO PHYSICAL THERAPY
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1756
Practice Address - Country:US
Practice Address - Phone:607-334-5010
Practice Address - Fax:607-336-7326
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-039828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist