Healthcare Provider Details

I. General information

NPI: 1518431378
Provider Name (Legal Business Name): BRIANA THUY THAO NGUYEN-PENNER PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 MAIN ST STE 6
BILLINGS MT
59105-2555
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171-1185
US

V. Phone/Fax

Practice location:
  • Phone: 406-206-6888
  • Fax:
Mailing address:
  • Phone: 801-942-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: