Provider Demographics
NPI:1306667050
Name:PHAN, STEVEN THIEN CHI
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:THIEN CHI
Last Name:PHAN
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 1:8003 SUMMER ROSE LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1847
Mailing Address - Country:US
Mailing Address - Phone:409-454-5153
Mailing Address - Fax:
Practice Address - Street 1:8003 SUMMER ROSE LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1847
Practice Address - Country:US
Practice Address - Phone:409-454-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2183115225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant