Provider Demographics
NPI:1982249033
Name:NGUYEN, MICHELLE PHUONG-UYEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PHUONG-UYEN
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 1:3229 ADELANTO LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1059
Mailing Address - Country:US
Mailing Address - Phone:408-219-8804
Mailing Address - Fax:
Practice Address - Street 1:1541 OLD BAYSHORE HWY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1602
Practice Address - Country:US
Practice Address - Phone:650-638-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2977152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics