Basic Information
| Provider Information | |||||||||
| NPI: | 1275015711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | SUSAN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1284 SHELBY CREEK LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951204260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626192720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 HOSPITAL PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951191103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089723000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23664 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.