Individual
KY VIET PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5432 SPRINGWATER DR, BATON ROUGE, LA 70817-2457
(228) 238-9200
Mailing address
5432 SPRINGWATER DR, BATON ROUGE, LA 70817-2457
(228) 238-9200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A3976
LA
Other
Enumeration date
07/03/2009
Last updated
07/03/2009
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