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General NPI Number Information
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NPI Number | 1811737646
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Entity Type | Individual
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Provider Name | PHUONG THANH NGUYEN LMT, LHC
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 4909 E HIGHWAY 22
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City | PANAMA CITY
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State | FL
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Zip | 32404-6233
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Country | US
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Telephone | 850-358-8535
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Fax |
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Provider Business Mailing Address
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Address Line | 4909 E HIGHWAY 22
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City | PANAMA CITY
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State | FL
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Zip | 32404-6233
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MS80246
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License Number State | FL
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