Provider Demographics
NPI:1780964551
Name:PHUT, CHHOVY HIM (LMP)
Entity type:Individual
Prefix:
First Name:CHHOVY
Middle Name:HIM
Last Name:PHUT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 132ND ST SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-379-6301
Mailing Address - Fax:425-379-5761
Practice Address - Street 1:2003 132ND ST SE
Practice Address - Street 2:SUITE E
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-379-6301
Practice Address - Fax:425-379-5761
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60233557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist