MEDICARE: CUONG LY PTA

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	225200000X	Physical Therapy Assistant	2187894	TX

General Provider Information

NPI Number	:	1306793468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CUONG LY PTA

Provider Business Mailing Address
First Line	:	6445 FM 1463 RD STE 290
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4028
Country	:	US
Telephone Number	:	979-464-5000
Fax Number	:	979-464-5001

Provider Business Practice Location Address
First Line	:	6445 FM 1463 RD STE 290
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4028
Country	:	US
Telephone Number	:	979-464-5000
Fax Number	:	979-464-5001

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ CUONG LY PTA” Practice Location

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