MEDICARE: ANH THU THAO NGUYEN-DAO 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	38203	CA

General Provider Information

NPI Number	:	1194076133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANH THU THAO NGUYEN-DAO DPT

Provider Business Mailing Address
First Line	:	1414 STEWART DR.
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533
Country	:	US
Telephone Number	:	916-420-7930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 ESTATES DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-9711
Country	:	US
Telephone Number	:	707-207-7835
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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