MEDICARE: TOMMY NGO PT, DPT, CAFS

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

General Provider Information

NPI Number	:	1740944636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMY NGO PT, DPT, CAFS

Provider Business Mailing Address
First Line	:	11667 COMPASS POINT DR N UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-5589
Country	:	US
Telephone Number	:	949-331-4974
Fax Number	:

Provider Business Practice Location Address
First Line	:	11667 COMPASS POINT DR N UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-5589
Country	:	US
Telephone Number	:	949-331-4974
Fax Number	:

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

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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