Tom Long Hoang Phan, DPT PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT32562 Issued in FL

Practice address

1 University Blvd
St Augustine, FL 32086-5799

Phone

(904) 829-3411

Fax

(904) 829-3412

NPI assigned

May 31, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Rehabilitation Inc

  • Physical Therapist
  • Valrico, FL
  • NPI 1427505627
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1114455458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4539 S DALE MABRY HWY",
            "address_2": "STE 110",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336111404",
            "telephone_number": "904-829-3411",
            "fax_number": "904-829-3412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865799",
            "telephone_number": "904-829-3411",
            "fax_number": "904-829-3412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "TOM",
        "middle_name": "LONG HOANG",
        "credential": "DPT PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT32562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marni Anna Peterson, LMFT, DMFT
• Anthony Robert Petrone, D.M.D.
• Joseph Pezak Jr.
• Vincent C Pfab, RPH
• Julie Pham
• Phases of Healing, Counseling and Therapy LLC
• Jasmin Nikole Phiel
• Celina T Philip, RPH
• Ashton Phillips, APRN
• Christina Marie Tipple Phillips, OT

• Physical Therapist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.