Provider Demographics
NPI:1265145999
Name:CHUTIMA PHANPHO PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:CHUTIMA PHANPHO PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHUTIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHANPHO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-652-8218
Mailing Address - Street 1:4141 46TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1818
Mailing Address - Country:US
Mailing Address - Phone:347-652-8218
Mailing Address - Fax:
Practice Address - Street 1:4141 46TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1818
Practice Address - Country:US
Practice Address - Phone:347-652-8218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty