Provider Demographics
NPI:1003607359
Name:PHU, JASON VINH (DPT, PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:VINH
Last Name:PHU
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GRISSOM PL
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1010
Mailing Address - Country:US
Mailing Address - Phone:201-844-2137
Mailing Address - Fax:
Practice Address - Street 1:2751 O'VARSITY WAY ROOM 265
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-0001
Practice Address - Country:US
Practice Address - Phone:201-844-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist