Provider Demographics
NPI:1487922175
Name:NGUYEN, MARY GRACE (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 18
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3600
Mailing Address - Country:US
Mailing Address - Phone:941-924-3022
Mailing Address - Fax:941-925-4943
Practice Address - Street 1:4141 S TAMIAMI TRL
Practice Address - Street 2:SUITE 18
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3600
Practice Address - Country:US
Practice Address - Phone:941-924-3022
Practice Address - Fax:941-925-4943
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist