Provider Demographics
NPI:1639904329
Name:CHACHOUTE, BRIANNA ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ROSE
Last Name:CHACHOUTE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NASSAU PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5949
Mailing Address - Country:US
Mailing Address - Phone:609-606-1890
Mailing Address - Fax:
Practice Address - Street 1:660 NASSAU PARK BLVD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5949
Practice Address - Country:US
Practice Address - Phone:609-606-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02286400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist