Provider Demographics
NPI:1154191856
Name:VONGMEPUNT, CHAYUT GORDON (DPT)
Entity type:Individual
Prefix:
First Name:CHAYUT
Middle Name:GORDON
Last Name:VONGMEPUNT
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W HORIZON RIDGE PKWY APT 1921
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5792
Mailing Address - Country:US
Mailing Address - Phone:702-882-2022
Mailing Address - Fax:
Practice Address - Street 1:149 N GIBSON RD STE H
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6763
Practice Address - Country:US
Practice Address - Phone:702-558-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist