Provider Demographics
NPI:1053312991
Name:CHADHA, CHARAN TONY (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHARAN
Middle Name:TONY
Last Name:CHADHA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3004
Mailing Address - Country:US
Mailing Address - Phone:484-582-0660
Mailing Address - Fax:484-582-0666
Practice Address - Street 1:215 SUGARTOWN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3004
Practice Address - Country:US
Practice Address - Phone:484-582-0660
Practice Address - Fax:484-582-0666
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012134L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092222UCTMedicare ID - Type UnspecifiedPROVIDER NUMBER