Healthcare Provider Details

I. General information

NPI: 1417469909
Provider Name (Legal Business Name): TUONG-LINH PHAM VU PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 SAMARITAN DR
SAN JOSE CA
95124-4101
US

IV. Provider business mailing address

7 KIRK AVE
SAN JOSE CA
95127-2215
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-8181
  • Fax:
Mailing address:
  • Phone: 408-482-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number43378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: