Basic Information
| Provider Information | |||||||||
| NPI: | 1679205793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHETTIAR | ||||||||
| FirstName: | ELISEUS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 MAYBROOK RD STE L | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL HALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109162741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456364344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 338 ROUTE 212 STE 3 | ||||||||
| Address2: | |||||||||
| City: | SAUGERTIES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124775118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452172394 | ||||||||
| FaxNumber: | 8454069357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 048740 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.