Provider Demographics
NPI:1750467197
Name:CHU, LISA (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHU
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 1:5901 S LOS ALTOS PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8616
Mailing Address - Country:US
Mailing Address - Phone:775-354-1188
Mailing Address - Fax:775-354-1187
Practice Address - Street 1:5901 S LOS ALTOS PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8616
Practice Address - Country:US
Practice Address - Phone:775-354-1188
Practice Address - Fax:775-354-1187
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1304225100000X
NV05061162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer