Provider Demographics
NPI:1841920139
Name:NGUYEN, ANGEL KIM (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
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 1:105 LAGUNA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5673
Mailing Address - Country:US
Mailing Address - Phone:682-472-8422
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY STE 170
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5597
Practice Address - Country:US
Practice Address - Phone:972-723-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1362203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist