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General NPI Number Information
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NPI Number | 1689225930
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Entity Type | Individual
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Provider Name | PHUONG THAI THACH NMD, AP, DIPL. O.M.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 07/23/2022
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Provider Practice Location Address
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Address Line | 7700 US-98
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City | PENSACOLA
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State | FL
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Zip | 32506
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Country | US
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Telephone | 425-333-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 10775 CREEK RIDGE DR
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City | PENSACOLA
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State | FL
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Zip | 32506-8217
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Country | US
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Telephone | 850-304-7881
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 4359
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT60999770
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License Number State | WA
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