Provider Demographics
NPI:1851877104
Name:YOOBHAT, JITTDAROON
Entity Type:Individual
Prefix:MISS
First Name:JITTDAROON
Middle Name:
Last Name:YOOBHAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 HATILLO AVE APT E
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3947
Mailing Address - Country:US
Mailing Address - Phone:818-445-7401
Mailing Address - Fax:
Practice Address - Street 1:6858 HATILLO AVE APT E
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3947
Practice Address - Country:US
Practice Address - Phone:818-445-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant