Healthcare Provider Details

I. General information

NPI: 1750122057
Provider Name (Legal Business Name): SYDNEY NGUYEN PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 FM 1187 #500
ALEDO TX
76008
US

IV. Provider business mailing address

15209 BELCLAIRE AVE
ALEDO TX
76008-2042
US

V. Phone/Fax

Practice location:
  • Phone: 817-615-9214
  • Fax:
Mailing address:
  • Phone: 281-896-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1393688
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1393688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: