MEDICARE: FRANK QUOC PHAM 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	208100000X	Physical Medicine & Rehabilitation Physician	2018034752	MO

General Provider Information

NPI Number	:	1942785365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK QUOC PHAM PTA

Provider Business Mailing Address
First Line	:	5107 VIRGINIA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-2517
Country	:	US
Telephone Number	:	816-529-6537
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 VIRGINIA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-2517
Country	:	US
Telephone Number	:	816-529-6537
Fax Number	:

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/02/2018

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