Individual
DR. TARAH JUDITH AN PHONGSAVATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
601 E 63RD ST, KANSAS CITY, MO 64110-3303
(816) 569-2802
(816) 569-5436
Mailing address
24850 W 191ST ST, GARDNER, KS 66030-9402
(913) 549-6416
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-07644
KS
Other
Enumeration date
07/19/2024
Last updated
08/13/2024
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