Provider Demographics
NPI:1427625854
Name:NGO, BRYANT THANH (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:THANH
Last Name:NGO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10434 ENLOE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2144
Mailing Address - Country:US
Mailing Address - Phone:626-391-7071
Mailing Address - Fax:
Practice Address - Street 1:30212 TOMAS STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2173
Practice Address - Country:US
Practice Address - Phone:949-709-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist