Healthcare Provider Details

I. General information

NPI: 1538363163
Provider Name (Legal Business Name): PHUNG KIM TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S ALTON WAY STE B-110
CENTENNIAL CO
80112-2201
US

IV. Provider business mailing address

13548 ANTARES DR
LITTLETON CO
80124-2510
US

V. Phone/Fax

Practice location:
  • Phone: 720-489-0790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number603
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: