Healthcare Provider Details

I. General information

NPI: 1760269690
Provider Name (Legal Business Name): THAO THANH NGUYEN PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LIMESTONE DR
WILLIAMSVILLE NY
14221-7178
US

IV. Provider business mailing address

924 MAIN ST
NIAGARA FALLS NY
14301-1110
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-2888
  • Fax: 716-285-1281
Mailing address:
  • Phone: 716-282-2888
  • Fax: 716-285-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: