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General NPI Number Information
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NPI Number | 1154191856
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Entity Type | Individual
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Provider Name | CHAYUT GORDON VONGMEPUNT DPT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 149 N GIBSON RD STE H
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City | HENDERSON
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State | NV
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Zip | 89014-6763
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Country | US
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Telephone | 702-558-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 W HORIZON RIDGE PKWY APT 1921
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City | HENDERSON
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State | NV
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Zip | 89052-5792
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Country | US
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Telephone | 702-882-2022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6318
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License Number State | NV
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