Provider Demographics
NPI:1447814868
Name:NGUYEN, MICHELLE QUYNH (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:QUYNH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 WEDD ST
Mailing Address - Street 2:12
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:
Practice Address - Street 1:15315 W 67TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217
Practice Address - Country:US
Practice Address - Phone:913-632-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2025-02-13
Deactivation Date:2024-12-12
Deactivation Code:
Reactivation Date:2025-02-12
Provider Licenses
StateLicense IDTaxonomies
KS11-07699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist