Provider Demographics
NPI:1265478317
Name:THONGSOUM-LOVANH, BOUNVILAY TOPPY (MPT)
Entity Type:Individual
Prefix:
First Name:BOUNVILAY
Middle Name:TOPPY
Last Name:THONGSOUM-LOVANH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:200 ARMY POST RD
Practice Address - Street 2:SUITE 38&40
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6203
Practice Address - Country:US
Practice Address - Phone:515-953-6911
Practice Address - Fax:515-953-6913
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004899225100000X
IA03615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist