Provider Demographics
NPI:1568635639
Name:CHU, JON DAVID (MA, MSPT, CSCS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
Last Name:CHU
Suffix:
Gender:M
Credentials:MA, MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-9316
Mailing Address - Country:US
Mailing Address - Phone:888-538-0573
Mailing Address - Fax:888-538-0573
Practice Address - Street 1:3498 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672-9625
Practice Address - Country:US
Practice Address - Phone:888-538-0573
Practice Address - Fax:888-538-0573
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34567225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics