Rasavong, Futachai

Rasavong, Futachai is an individual health care provider with primary practice located at 5301 S 108Th St , Hales Corners WI 53130-1332. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Rasavong, Futachai can be contacted via phone (414) 529-7375.

Contact Information

Primary practice address
5301 S 108Th St Hales Corners WI 53130-1332
Phone: (414) 529-7375
Fax: (414) 529-7567
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 9557024 Wisconsin

Profile Details

NPI number 1225184013
LBN Legal business name Rasavong, Futachai
Credentials Master of Physical Therapy (MPT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2007
Last updated Jul 9th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225184013 NPPES
Wisconsin MEDICAID 100017332

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