Individual
THEERASAKDI VACHRANUKUNKIET
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 EASTON RD, WILLOW GROVE, PA 19090-2003
(215) 820-9568
(215) 830-9579
Mailing address
701 EASTON RD, WILLOW GROVE, PA 19090-2003
(215) 820-9568
(215) 830-9579
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD034954L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000775850-005
—
PA
Enumeration date
09/14/2005
Last updated
07/08/2007
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