Provider Demographics
NPI:1770972671
Name:VICHAYANONDA, JEANI (DPT)
Entity type:Individual
Prefix:MS
First Name:JEANI
Middle Name:
Last Name:VICHAYANONDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 REGENCY PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3071
Mailing Address - Country:US
Mailing Address - Phone:301-934-5336
Mailing Address - Fax:
Practice Address - Street 1:4470 REGENCY PL
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3071
Practice Address - Country:US
Practice Address - Phone:301-934-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist