Provider Demographics
NPI:1245502236
Name:NORAVONG, GARRY
Entity type:Individual
Prefix:MR
First Name:GARRY
Middle Name:
Last Name:NORAVONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15104 S ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3050
Mailing Address - Country:US
Mailing Address - Phone:913-709-5553
Mailing Address - Fax:
Practice Address - Street 1:15104 S ARAPAHO DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3050
Practice Address - Country:US
Practice Address - Phone:913-709-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant