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General NPI Number Information
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NPI Number | 1184268666
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Entity Type | Individual
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Provider Name | TONY HOANG NGUYEN LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 101 UNIVERSITY DR
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City | RADFORD
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State | VA
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Zip | 24141
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Country | US
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Telephone | 540-831-7831
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6913
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City | RADFORD
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State | VA
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Zip | 24142-6913
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0126003278
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License Number State | VA
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