Basic Information
| Provider Information | |||||||||
| NPI: | 1548819485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2579 OCEAN AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112294552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467800926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2579 OCEAN AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112294552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467800926 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2019 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 044630 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.