Provider Demographics
NPI:1457619744
Name:CHUA, AGATHAREZA N (LMP)
Entity Type:Individual
Prefix:
First Name:AGATHAREZA
Middle Name:N
Last Name:CHUA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AGGIE
Other - Middle Name:N
Other - Last Name:CHUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:5406 54TH AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4819
Mailing Address - Country:US
Mailing Address - Phone:808-779-6123
Mailing Address - Fax:
Practice Address - Street 1:2310 MILDRED ST W STE 130
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6055
Practice Address - Country:US
Practice Address - Phone:253-460-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60281707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist