Most Relevant Information
Provider Data
| NPI Number: | 1003031899 |
| Provider Name: | ANOCHA SUPHOL MPT |
| Entity Type: | Individual |
| Taxonomy Code: | 2251S0007X |
| Specialty: | Physical Therapist |
| License Number: | PT27871 |
Most Important Dates
| Enumeration Date: | 04/16/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
4444 MAGNOLIA AVE
RIVERSIDE
CA
925014136
Practice Location Phone/Fax
| Phone: | 9512743524 |
| Fax: | 9512743442 |
Provider Mailing Location
4444 MAGNOLIA AVE
RIVERSIDE
CA
925014136
Provider Mailing Phone/Fax
| Phone: | 9512743524 |
| Fax: | 9512743442 |