Provider Demographics
NPI:1619566346
Name:UTHAIRAK, PANNEE (LMT)
Entity Type:Individual
Prefix:
First Name:PANNEE
Middle Name:
Last Name:UTHAIRAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 9TH AVE APT 4FN
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3648
Mailing Address - Country:US
Mailing Address - Phone:347-899-7937
Mailing Address - Fax:
Practice Address - Street 1:644 9TH AVE APT 4FN
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3648
Practice Address - Country:US
Practice Address - Phone:347-899-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
029690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist