Provider Demographics
NPI:1932394954
Name:CHACKO, PREYA SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:PREYA
Middle Name:SUZANNE
Last Name:CHACKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PREYA
Other - Middle Name:SUZANNE
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7 ECKERSON LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3130
Mailing Address - Country:US
Mailing Address - Phone:845-356-7526
Mailing Address - Fax:
Practice Address - Street 1:7 ECKERSON LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3130
Practice Address - Country:US
Practice Address - Phone:845-356-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 029678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist