MEDICARE: JONATHAN T TRUONG 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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1386206316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN T TRUONG DPT

Provider Business Mailing Address
First Line	:	2111 TEVIS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 TEVIS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3352
Country	:	US
Telephone Number	:	650-245-5069
Fax Number	:

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

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	06/29/2019

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