Provider Demographics
NPI:1376203372
Name:VU, ADELBERT ANDERSON (PT)
Entity type:Individual
Prefix:
First Name:ADELBERT
Middle Name:ANDERSON
Last Name:VU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 PEACOCK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1931
Mailing Address - Country:US
Mailing Address - Phone:949-345-9190
Mailing Address - Fax:
Practice Address - Street 1:1101 S MILLIKEN AVE STE C
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8112
Practice Address - Country:US
Practice Address - Phone:909-390-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist