Provider Demographics
NPI:1316078389
Name:TRAN, ANDY (PT)
Entity type:Individual
Prefix:MR
First Name:ANDY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BAKER ST APT U102
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4453
Mailing Address - Country:US
Mailing Address - Phone:714-475-4501
Mailing Address - Fax:
Practice Address - Street 1:8341 WESTMINSTER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3306
Practice Address - Country:US
Practice Address - Phone:714-891-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist