MEDICARE: TUAN M NGUYEN P.T., OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6979	SC

General Provider Information

NPI Number	:	1053489211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUAN M NGUYEN P.T., OCS

Provider Business Mailing Address
First Line	:	616 EDGEFIELD RD
Second Line	:	SUITE 150
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-1938
Country	:	US
Telephone Number	:	803-634-6983
Fax Number	:	888-972-1745

Provider Business Practice Location Address
First Line	:	616 EDGEFIELD RD
Second Line	:	SUITE 150
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-1938
Country	:	US
Telephone Number	:	803-634-6983
Fax Number	:	888-972-1745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/23/2013

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