Provider Demographics
NPI:1053441758
Name:CHINNAN, ASHLEY SARA (PT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:SARA
Last Name:CHINNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SOUTH COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5918
Mailing Address - Country:US
Mailing Address - Phone:516-837-0509
Mailing Address - Fax:516-599-0856
Practice Address - Street 1:28 SOUTH COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5918
Practice Address - Country:US
Practice Address - Phone:516-837-0509
Practice Address - Fax:516-599-0856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023855-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist