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Individual

LOAN PHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
316 N 11TH ST, FULTON, TX 78358
(713) 303-5678
Mailing address
PO BOX 1554, FULTON, TX 78358-1554
(713) 303-5678

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214478
TX

Other

Enumeration date
01/25/2021
Last updated
01/25/2021
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