Provider Demographics
NPI:1003308123
Name:CHUA SY, CARMELLE
Entity Type:Individual
Prefix:
First Name:CARMELLE
Middle Name:
Last Name:CHUA SY
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 1:1032 VEGA AVE NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2071
Mailing Address - Country:US
Mailing Address - Phone:941-585-9114
Mailing Address - Fax:
Practice Address - Street 1:1032 VEGA AVE NW
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2071
Practice Address - Country:US
Practice Address - Phone:941-585-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist