Provider Demographics
NPI:1184018574
Name:LIN, CHIA-CHENG (PT, PHD, MS)
Entity Type:Individual
Prefix:
First Name:CHIA-CHENG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:PT, PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-0172
Practice Address - Fax:252-744-0229
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP149632251N0400X, 225100000X
PAPT0235342251N0400X
NY0375302251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184018574Medicaid
NC19B7JOtherBCBSNC
NC19B7JOtherBCBSNC
NCQ504400322Medicare PIN