Bouakham Chanthavongnasaeng
Physical Therapy Assistant in Deerfield Beach, FL. Individual provider (NPI-1).
NPI number1346829751
StatusActive
Last updated in NPPESApr 4, 2021
Details
- NPI
- 1346829751
- Entity type
- Individual (NPI-1)
- Name
- Bouakham Chanthavongnasaeng
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 4, 2021
- Certification date
- Apr 4, 2021
- Last updated
- Apr 4, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | PTA25966 | FL | Yes |
| 225200000X | Physical Therapy Assistant | – | – |
Practice location
401 E Sample RdDeerfield Beach, FL 33064-4441
Phone 954-941-4100
Mailing address
103 Royal Park Dr Apt 4cOakland Park, FL 33309-5832
Phone 352-222-3730
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All 26 Physical Therapy Assistant providers in Deerfield Beach · All 4,521 providers in Deerfield Beach
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