Provider Demographics
NPI:1063182269
Name:CHANYATHUNYAROJ, PINYAPATCH
Entity type:Individual
Prefix:
First Name:PINYAPATCH
Middle Name:
Last Name:CHANYATHUNYAROJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 BUCKNAM ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-1221
Mailing Address - Country:US
Mailing Address - Phone:617-396-1752
Mailing Address - Fax:
Practice Address - Street 1:588 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4124
Practice Address - Country:US
Practice Address - Phone:617-396-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist