Provider Demographics
NPI:1174240782
Name:PHONG, ANDREW (DPT, PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PHONG
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2341
Mailing Address - Country:US
Mailing Address - Phone:415-806-5028
Mailing Address - Fax:
Practice Address - Street 1:421 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2903
Practice Address - Country:US
Practice Address - Phone:415-388-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist