Provider Demographics
NPI:1447869771
Name:LE, NGOC ANH LUU (PTA)
Entity type:Individual
Prefix:
First Name:NGOC ANH
Middle Name:LUU
Last Name:LE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CHIPMUNK DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-4789
Mailing Address - Country:US
Mailing Address - Phone:501-694-1609
Mailing Address - Fax:
Practice Address - Street 1:141 CHIPMUNK DR
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-4789
Practice Address - Country:US
Practice Address - Phone:501-694-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4533225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty