Provider Demographics
NPI:1346775913
Name:CHINGCUANGCO, ROSEANN (DPT)
Entity Type:Individual
Prefix:MS
First Name:ROSEANN
Middle Name:
Last Name:CHINGCUANGCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ROSIE
Other - Middle Name:
Other - Last Name:CHINGCUANGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:15107 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4542
Mailing Address - Country:US
Mailing Address - Phone:818-902-2941
Mailing Address - Fax:
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-902-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist