Healthcare Provider Details

I. General information

NPI: 1750989885
Provider Name (Legal Business Name): TINA THAOMY NGUYEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W HORIZON RIDGE PKWY STE 320
HENDERSON NV
89052-4395
US

IV. Provider business mailing address

2780 AGUEDA PL
HENDERSON NV
89044-1961
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-4116
  • Fax: 702-932-2403
Mailing address:
  • Phone: 858-357-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298984
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6350
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: