Provider Demographics
NPI:1861970170
Name:VO, KHOA D
Entity type:Individual
Prefix:
First Name:KHOA
Middle Name:D
Last Name:VO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 WILLOWOOD CIR APT 1235
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3300
Mailing Address - Country:US
Mailing Address - Phone:315-219-3318
Mailing Address - Fax:
Practice Address - Street 1:1901 N HWY 360 STE 410
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1431
Practice Address - Country:US
Practice Address - Phone:817-652-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008984225200000X
TX2135429225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant