Provider Demographics
NPI:1376176685
Name:CHIN, EUNICE SALAMITAO
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:SALAMITAO
Last Name:CHIN
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 1:1300 N 45TH ST APT 1924
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1736
Mailing Address - Country:US
Mailing Address - Phone:254-661-8124
Mailing Address - Fax:
Practice Address - Street 1:500 W 3RD AVE STE 6
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4564
Practice Address - Country:US
Practice Address - Phone:903-872-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1258471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist