Healthcare Provider Details

I. General information

NPI: 1831034883
Provider Name (Legal Business Name): VIVIAN PHAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 SPRINGFIELD PIKE
CINCINNATI OH
45215-1437
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-873-3251
  • Fax: 513-354-7651
Mailing address:
  • Phone: 205-545-2717
  • Fax: 513-354-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP054221T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: