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1093446221
TRUNG TIN PHAN
SUWANEE, GA
NPI
1093446221
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: GA PT015913)
Enumeration Date
2022-06-20
Last Update Date
2022-06-20
Business Address
TRUNG TIN PHAN
4310 JOHNS CREEK PKWY STE 130
SUWANEE, GA 30024-6092
Phone number: 770-738-9657
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Mailing Address
TRUNG TIN PHAN
2381 EASTWAY RD
DECATUR, GA 30033-5543
Phone number: 916-719-1709
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