Provider Demographics
NPI:1467428565
Name:CHLETSOS, SALLY JEAN (RPT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JEAN
Last Name:CHLETSOS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2705
Mailing Address - Country:US
Mailing Address - Phone:973-383-8557
Mailing Address - Fax:973-383-7443
Practice Address - Street 1:8 CLUB RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2705
Practice Address - Country:US
Practice Address - Phone:973-383-8557
Practice Address - Fax:973-383-7443
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA000091200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist