Provider Demographics
NPI:1518339761
Name:CHACONAS, CINDY O (DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:O
Last Name:CHACONAS
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S
Mailing Address - Street 2:STE 203A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3111
Mailing Address - Country:US
Mailing Address - Phone:904-461-0821
Mailing Address - Fax:904-461-0823
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 203A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3111
Practice Address - Country:US
Practice Address - Phone:904-461-0821
Practice Address - Fax:904-461-0823
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist