Provider Demographics
NPI:1215749361
Name:NGUYEN, KHA LIENBAO (PTA)
Entity type:Individual
Prefix:
First Name:KHA
Middle Name:LIENBAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LIENBAO
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25707 OAKWOOD KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5993
Mailing Address - Country:US
Mailing Address - Phone:832-209-0623
Mailing Address - Fax:
Practice Address - Street 1:25707 OAKWOOD KNOLL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5993
Practice Address - Country:US
Practice Address - Phone:832-209-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2172041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant