Provider Demographics
NPI:1912181710
Name:CHUA, CARL DEXTER (PT)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DEXTER
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 1:6110 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3903
Mailing Address - Country:US
Mailing Address - Phone:240-833-2921
Mailing Address - Fax:
Practice Address - Street 1:6110 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-833-2921
Practice Address - Fax:240-833-2937
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist