Provider Demographics
NPI:1912139817
Name:CHUA, JENNILYN SY
Entity Type:Individual
Prefix:MS
First Name:JENNILYN
Middle Name:SY
Last Name:CHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 VILLAGE RD APT 12
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7410
Mailing Address - Country:US
Mailing Address - Phone:443-813-4834
Mailing Address - Fax:
Practice Address - Street 1:7405 VILLAGE RD APT 12
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7410
Practice Address - Country:US
Practice Address - Phone:443-813-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist