MEDICARE: ANGIE T NGUYEN P.T,

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	8733	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	066615	OTHER	CO	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1356567960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE T NGUYEN P.T,

Provider Business Mailing Address
First Line	:	12211W ALAMEDA PKWY 104
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2825
Country	:	US
Telephone Number	:	720-519-1548
Fax Number	:	720-519-1698

Provider Business Practice Location Address
First Line	:	9195 GRANT ST
Second Line	:	SUITE 100
City	:	THORNTON
State	:	CO
Zip	:	80229-4386
Country	:	US
Telephone Number	:	303-451-7700
Fax Number	:	303-252-9474

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/12/2015

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Directions to “ ANGIE T NGUYEN P.T,” Practice Location

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