Healthcare Provider Details

I. General information

NPI: 1093534539
Provider Name (Legal Business Name): MICHAEL QUY HOANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6264 FERRIS SQ
SAN DIEGO CA
92121-3204
US

IV. Provider business mailing address

10521 STONY RIDGE WAY
SAN DIEGO CA
92131-6139
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-4128
  • Fax:
Mailing address:
  • Phone: 858-610-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: