Provider Demographics
NPI:1265048235
Name:RATTANAMETHANON, LERTCHAI (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:LERTCHAI
Middle Name:
Last Name:RATTANAMETHANON
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:KAI
Other - Middle Name:
Other - Last Name:LECHAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5845 DOVERWOOD DR UNIT 213
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7216
Mailing Address - Country:US
Mailing Address - Phone:310-793-6277
Mailing Address - Fax:
Practice Address - Street 1:5845 DOVERWOOD DR UNIT 213
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7216
Practice Address - Country:US
Practice Address - Phone:310-793-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist