Healthcare Provider Details

I. General information

NPI: 1679150940
Provider Name (Legal Business Name): VAN NGUYEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

IV. Provider business mailing address

1985 NEEDMORE RD UNIT 1310
CLARKSVILLE TN
37042-4791
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2739
  • Fax:
Mailing address:
  • Phone: 816-699-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number13453
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: