Individual
JENNIE D PHOUTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 LANTERN CREST WAY, SANTEE, CA 92071-4775
(619) 312-0929
Mailing address
13063 WIMBERLY SQ UNIT 115, SAN DIEGO, CA 92128-6023
(619) 994-3220
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA48583
CA
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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