Provider Demographics
NPI:1316785371
Name:HA, BRUCE LOC THIEN NGUYEN (DPT,PT)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LOC THIEN NGUYEN
Last Name:HA
Suffix:
Gender:M
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1409
Mailing Address - Country:US
Mailing Address - Phone:888-822-8436
Mailing Address - Fax:
Practice Address - Street 1:1923 ROBINHOOD CIR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2509
Practice Address - Country:US
Practice Address - Phone:573-837-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024005767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist