Sy Labthavikul, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

9796 Issued in OR

Practice address

10915 SE Stark St
Portland, OR 97216-3348

Phone

(503) 261-1120

NPI assigned

Jan 25, 2024

Last updated

Jan 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1346002250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 SE 30TH PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141921",
            "telephone_number": "845-598-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10915 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163348",
            "telephone_number": "503-261-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABTHAVIKUL",
        "first_name": "SY",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "9796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Labray, PSYD
• Melanie Labrie, CRM
• Alan Labrum, O.D.
• Danielle Jeannine Labruzzo, MS
• Sharon M. Labs, PH.D.
• Victoria K Labuhn, RN
• Labyrinth Counseling LLC
• My Hai Lac, DMD
• Aimee N Lacaden
• Kiana Lacaden

• Physical Therapy Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.