Provider Demographics
NPI:1154917813
Name:VY, PHISON DAI
Entity type:Individual
Prefix:
First Name:PHISON
Middle Name:DAI
Last Name:VY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 OLD GREENVILLE HWY STE 500-1
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1787
Practice Address - Country:US
Practice Address - Phone:864-722-6037
Practice Address - Fax:864-722-6038
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCCP032698T225100000X, 225100000X
SC10468225100000X, 225100000X
NMPT6153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist