Provider Demographics
NPI:1740324599
Name:CHACKO, TINU THOMAS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TINU
Middle Name:THOMAS
Last Name:CHACKO
Suffix:
Gender:M
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 1:1300 W WALNUT HILL LN
Mailing Address - Street 2:STE 240
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2928
Mailing Address - Country:US
Mailing Address - Phone:972-756-9500
Mailing Address - Fax:972-756-9501
Practice Address - Street 1:1300 W WALNUT HILL LN
Practice Address - Street 2:SUITE- 240
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3000
Practice Address - Country:US
Practice Address - Phone:214-492-3947
Practice Address - Fax:972-506-3007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist