Provider Demographics
NPI:1679249296
Name:CHUA, JOSEPH BENZON (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH BENZON
Middle Name:
Last Name:CHUA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 SUNDANCE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2337
Mailing Address - Country:US
Mailing Address - Phone:626-589-0019
Mailing Address - Fax:
Practice Address - Street 1:2304 SUNDANCE ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2337
Practice Address - Country:US
Practice Address - Phone:626-589-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist