Individual
FUTACHAI RASAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.T.
Contact information
Practice address
5301 S 108TH ST, HALES CORNERS, WI 53130-1332
(414) 529-7375
(414) 529-7567
Mailing address
1726 W MORGAN AVE, MILWAUKEE, WI 53221-1634
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9557024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100017332
—
WI
Enumeration date
01/26/2007
Last updated
07/09/2021
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