Individual
MR. ANTHONY KHUNTONG PANBAMRUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2827 NORTHGATE BLVD, FORT WAYNE, IN 46835-2903
(260) 492-1498
(260) 492-1674
Mailing address
3516 UTAH DR, FORT WAYNE, IN 46815-6640
(260) 385-3517
(260) 492-1674
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002861A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1555-656
—
IN
Enumeration date
06/29/2007
Last updated
07/08/2007
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