MEDICARE: MARSHAL TRUONG 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	225100000X	Physical Therapist	301557	CA

General Provider Information

NPI Number	:	1477213296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHAL TRUONG PTA

Provider Business Mailing Address
First Line	:	11622 NORMA LN
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-2449
Country	:	US
Telephone Number	:	714-808-2791
Fax Number	:

Provider Business Practice Location Address
First Line	:	12151 DALE AVE
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680-3889
Country	:	US
Telephone Number	:	714-530-9100
Fax Number	:

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

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	08/26/2024

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Directions to “ MARSHAL TRUONG PTA” Practice Location

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