Healthcare Provider Details

I. General information

NPI: 1356142855
Provider Name (Legal Business Name): NAPHONG ANEKSIRIKUL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25647 RAMADA DR
VALENCIA CA
91355-2241
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 909-456-4563
  • Fax:
Mailing address:
  • Phone: 800-995-2673
  • Fax: 866-420-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: