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General NPI Number Information
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NPI Number | 1700076049
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Entity Type | Individual
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Provider Name | SOKUNTHEA NAU DPT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 8509 S US HIGHWAY 1
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-3346
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Country | US
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Telephone | 772-380-4549
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Fax | 772-210-8920
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Provider Business Mailing Address
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Address Line | 816 SW IDOL AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6726
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Country | US
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Telephone | 772-342-1020
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Fax | 772-210-8920
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT23414
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License Number State | FL
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