Healthcare Provider Details

I. General information

NPI: 1508230079
Provider Name (Legal Business Name): RUBEN HUYNH PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 EAST WEST HWY FOX CHASE REHAB
SILVER SPRING MD
20902-1817
US

IV. Provider business mailing address

3203 UNIVERSITY BLVD W
KENSINGTON MD
20895-1817
US

V. Phone/Fax

Practice location:
  • Phone: 301-987-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4142
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: