Provider Demographics
NPI:1366123655
Name:TRINH, JUSTIN VAN (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:VAN
Last Name:TRINH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9277
Mailing Address - Country:US
Mailing Address - Phone:321-841-3760
Mailing Address - Fax:321-841-3232
Practice Address - Street 1:1000 W BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9277
Practice Address - Country:US
Practice Address - Phone:321-841-3760
Practice Address - Fax:321-841-3232
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40557225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist