MEDICARE: VICTORIA PAIN AND REHABILITATION CONSULTANT PA

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	K3358	TX

General Provider Information

NPI Number	:	1427465475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA PAIN AND REHABILITATION CONSULTANT PA

Provider Business Mailing Address
First Line	:	5090 RICHMOND AVE, BOX 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056
Country	:	US
Telephone Number	:	361-578-7703
Fax Number	:	361-578-7719

Provider Business Practice Location Address
First Line	:	3388 SAGE RD UNIT P5
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7238
Country	:	US
Telephone Number	:	361-578-7703
Fax Number	:	361-578-7719

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUCI NGUYEN
Credential	:	MD
Telephone Number	:	361-578-7703

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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