Healthcare Provider Details

I. General information

NPI: 1235268533
Provider Name (Legal Business Name): VIVIAN T NGUYEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 HILLS RD
HOOKSETT NH
03106-2189
US

IV. Provider business mailing address

13 HILLS RD
HOOKSETT NH
03106-2189
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3740
  • Fax:
Mailing address:
  • Phone: 603-622-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2740
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30394966
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
IdentifierP00463023
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerMVP
# 3
Identifier08Y011606NH01
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerANTHEM BC/BS
# 4
Identifier7585894
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: