Individual
BOUAKHAM CHANTHAVONGNASAENG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 E SAMPLE RD, DEERFIELD BEACH, FL 33064-4441
(954) 941-4100
Mailing address
103 ROYAL PARK DR APT 4C, OAKLAND PARK, FL 33309-5832
(352) 222-3730
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA25966
FL
225200000X
Physical Therapy Assistant
—
—
Other
Enumeration date
04/04/2021
Last updated
04/04/2021
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