Provider Demographics
NPI:1881285609
Name:TAN, VINSON (PT, DPT)
Entity type:Individual
Prefix:
First Name:VINSON
Middle Name:
Last Name:TAN
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 1:807 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3811
Mailing Address - Country:US
Mailing Address - Phone:415-963-1769
Mailing Address - Fax:
Practice Address - Street 1:1850 SULLIVAN AVE STE 330
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-756-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist