MEDICARE: BINH PHAN 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	0013147	CO

General Provider Information

NPI Number	:	1861815219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BINH PHAN PTA

Provider Business Mailing Address
First Line	:	6868 S IVY ST APT 108
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-6264
Country	:	US
Telephone Number	:	714-642-7363
Fax Number	:

Provider Business Practice Location Address
First Line	:	6868 S IVY ST APT 108
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-6264
Country	:	US
Telephone Number	:	714-642-7363
Fax Number	:

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

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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Directions to “ BINH PHAN PTA” Practice Location

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