| Doctor Name: | ANOCHA SUPHOL |
| NPI Number: | 1003031899 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | PT27871 |
| Business Practice Address: | 4444 Magnolia Ave Riverside, CA - 925014136 |
| Business Phone Number: | 9512743524 |
| Business Fax Number: | 9512743442 |
| Mailing Address: | 4444 Magnolia Ave, RIVERSIDE |
| State: | CA |
| Postal Code: | 925014136 |
| Phone Number: | 9512743524 |
| Fax Number: | 9512743442 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | PT27871 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |