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General NPI Number Information
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NPI Number | 1639500820
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Entity Type | Individual
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Provider Name | VINCENT NGUYENPHAM PTA
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Gender | Male
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 4700 42ND AVE SW STE 510
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City | SEATTLE
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State | WA
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Zip | 98116-4583
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Country | US
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Telephone | 206-933-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 S HOLLY PARK DR
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City | SEATTLE
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State | WA
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Zip | 98118-3758
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P160339911
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License Number State | WA
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