Provider Demographics
NPI:1619769163
Name:LE, PHONG VAN (DPT)
Entity type:Individual
Prefix:DR
First Name:PHONG
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:PHONG
Other - Middle Name:VAN
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3827 S INCA ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3406
Mailing Address - Country:US
Mailing Address - Phone:303-668-9242
Mailing Address - Fax:
Practice Address - Street 1:8501 TURNPIKE DR UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7042
Practice Address - Country:US
Practice Address - Phone:303-430-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist