Provider Demographics
NPI:1811334188
Name:CHUA, JUDE THADDENS C III (PT)
Entity type:Individual
Prefix:
First Name:JUDE THADDENS
Middle Name:C
Last Name:CHUA
Suffix:III
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 1:10185 ROYAL ANN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3518
Mailing Address - Country:US
Mailing Address - Phone:650-477-6149
Mailing Address - Fax:
Practice Address - Street 1:5050 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 250
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4381
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist