Individual
KHOA D VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 N HWY 360 STE 410, GRAND PRAIRIE, TX 75050-1431
(817) 652-2924
Mailing address
3512 WILLOWOOD CIR APT 1235, ARLINGTON, TX 76015-3300
(315) 219-3318
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
008984
NY
225200000X
Physical Therapy Assistant
Primary
2135429
TX
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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