Provider Demographics
NPI:1275323693
Name:CHACKO, STEVE SAMUEL
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:SAMUEL
Last Name:CHACKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 MUSCOGEE TRL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1164
Mailing Address - Country:US
Mailing Address - Phone:214-529-8931
Mailing Address - Fax:
Practice Address - Street 1:4300 COTTON GIN RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4480
Practice Address - Country:US
Practice Address - Phone:469-437-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2187634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant