Individual
MR. SY LABTHAVIKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
Mailing address
412 SE 30TH PL, PORTLAND, OR 97214-1921
(845) 598-7495
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9796
OR
Other
Enumeration date
01/25/2024
Last updated
01/25/2024
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