Individual
JAYVIN DAVID SUNGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 S 12TH ST, ROCKY FORD, CO 81067-2128
(719) 254-3314
Mailing address
2307 1/2 BELLEVIEW AVE, LA JUNTA, CO 81050-3307
(719) 417-0099
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL.0015488
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346697471
—
CO
Enumeration date
05/17/2018
Last updated
05/17/2018
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