Provider Demographics
NPI:1457828642
Name:SUGAY, CHARLES (PTA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SUGAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-6085
Mailing Address - Country:US
Mailing Address - Phone:630-863-8692
Mailing Address - Fax:
Practice Address - Street 1:1189 PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-6085
Practice Address - Country:US
Practice Address - Phone:630-863-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant