Provider Demographics
NPI:1366708158
Name:PHAN, TIEN VAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:VAN
Last Name:PHAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DONNIE
Other - Middle Name:VAN
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6810 BIG BEND LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3510
Mailing Address - Country:US
Mailing Address - Phone:612-349-9393
Mailing Address - Fax:
Practice Address - Street 1:400 W ARBROOK BLVD STE 151
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3181
Practice Address - Country:US
Practice Address - Phone:817-472-8383
Practice Address - Fax:817-472-8386
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9641225100000X
TX1235831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist