Jennie D Phouthavong

NPI #1285429654 in Santee, California

Provider Information

NPI Number: 1285429654
Entity Type: Individual
Name: Jennie D Phouthavong
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Apr 14, 2025
Last Updated: Apr 14, 2025

Practice Location

Address: 300 LANTERN CREST WAY
City: Santee
State: California
ZIP Code: 92071-4775
Phone: (619) 312-0929

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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