Provider Demographics
NPI:1770399966
Name:NGUYEN, PHILLIP (PT, DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 ALOMA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9343
Mailing Address - Country:US
Mailing Address - Phone:321-999-9260
Mailing Address - Fax:321-999-9261
Practice Address - Street 1:4270 ALOMA AVE STE 150
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9343
Practice Address - Country:US
Practice Address - Phone:321-999-9260
Practice Address - Fax:321-999-9261
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist