Provider Demographics
NPI:1306259502
Name:HOANG, PHUONG DUONG-TUY (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:DUONG-TUY
Last Name:HOANG
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FAULKNER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1303
Mailing Address - Country:US
Mailing Address - Phone:813-957-3042
Mailing Address - Fax:
Practice Address - Street 1:16 FAULKNER ST APT 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1303
Practice Address - Country:US
Practice Address - Phone:813-957-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00010942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer