Individual
JESSE PHALANUKORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
489 BRICK BLVD, BRICK, NJ 08723-6055
(732) 895-7283
Mailing address
489 BRICK BLVD, BRICK, NJ 08723-6055
(732) 895-7283
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT61209291
WA
Other
Enumeration date
10/22/2020
Last updated
10/21/2021
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