MEDICARE: PAUL TRAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	J1-0003314	DE
2	225100000X	Physical Therapist	PT024383	PA

General Provider Information

NPI Number	:	1245610559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL TRAN DPT

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE
Second Line	:	STE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	213-365-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 N FRANKLIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2918
Country	:	US
Telephone Number	:	215-805-8537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	12/02/2019

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