Provider Demographics
NPI:1730905274
Name:RATTANAUNGKULLCHOK, PEERAT
Entity type:Individual
Prefix:
First Name:PEERAT
Middle Name:
Last Name:RATTANAUNGKULLCHOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 ALFREDA WAY APT B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1292
Mailing Address - Country:US
Mailing Address - Phone:415-859-1103
Mailing Address - Fax:
Practice Address - Street 1:2760 ALFREDA WAY APT B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1292
Practice Address - Country:US
Practice Address - Phone:415-859-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist