Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | WA |
NPI | 1023646882 |
---|---|
Provider Name | Ms. Chhorn Houn Pho |
First Address | Blaine, MN 55449-4508 |
Second Address | Lacey, WA 98516-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2020 |
Last Update Date | 19/01/2022 |