Provider Demographics
NPI:1285466284
Name:NGUYEN, PHILIP (LMT,CPT,CES)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LMT,CPT,CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 NOTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3843
Mailing Address - Country:US
Mailing Address - Phone:571-531-3263
Mailing Address - Fax:
Practice Address - Street 1:1485 CHAIN BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4513
Practice Address - Country:US
Practice Address - Phone:571-531-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist