Individual
ANOCHA SUPHOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
4444 MAGNOLIA AVE, RIVERSIDE, CA 92501-4136
(951) 274-3524
(951) 274-3442
Mailing address
4444 MAGNOLIA AVE, RIVERSIDE, CA 92501-4136
(951) 274-3524
(951) 274-3442
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT27871
CA
2251X0800X
Orthopedic Physical Therapist
PT27871
CA
Other
Enumeration date
04/16/2007
Last updated
09/11/2025
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