Individual
DAVID CHANTHABOUASITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5791 49TH ST N, SAINT PETERSBURG, FL 33709-2107
(727) 527-2100
Mailing address
2100 NORFOLK ST N, SAINT PETERSBURG, FL 33710-4933
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
22262
FL
Other
Enumeration date
09/24/2010
Last updated
09/24/2010
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