MEDICARE: JANE ML NGUYEN PT, DPT

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	PT018595	PA

General Provider Information

NPI Number	:	1144452723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE ML NGUYEN PT, DPT

Provider Business Mailing Address
First Line	:	955 ROSEWOOD DR
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-3006
Country	:	US
Telephone Number	:	215-266-9652
Fax Number	:

Provider Business Practice Location Address
First Line	:	6031 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-6008
Country	:	US
Telephone Number	:	267-538-5011
Fax Number	:

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	12/07/2022

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