Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT32797 | FL |
NPI | 1003308123 |
---|---|
Provider Name | Carmelle Chua Sy |
First Address | Port Charlotte, FL 33948-2071 |
Second Address | Port Charlotte, FL 33948-2071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |