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General NPI Number Information
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NPI Number | 1356160204
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Entity Type | Individual
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Provider Name | ANDREW THIEN DUONG
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Gender | Male
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 400 STERLING PLAZA DR STE 407
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32081-8562
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Country | US
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Telephone | 904-514-2571
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Fax |
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Provider Business Mailing Address
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Address Line | 9972 MAXWOOD CT
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8617
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Country | US
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Telephone | 904-514-2571
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 41956
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License Number State | FL
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