Provider Demographics
NPI:1881058998
Name:VONG, XUONG (LMT)
Entity type:Individual
Prefix:MR
First Name:XUONG
Middle Name:
Last Name:VONG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 W CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1114
Mailing Address - Country:US
Mailing Address - Phone:407-698-5511
Mailing Address - Fax:
Practice Address - Street 1:9301 SUMMIT CENTRE WAY
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-698-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 14537225700000X
FLMA-61943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist