Basic Information
| Provider Information | |||||||||
| NPI: | 1972829877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | MIMI | ||||||||
| MiddleName: | NINA | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 E 84TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125700209 | ||||||||
| FaxNumber: | 2125700197 | ||||||||
| Practice Location | |||||||||
| Address1: | 244 E 84TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125700209 | ||||||||
| FaxNumber: | 2125700197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2010 | ||||||||
| LastUpdateDate: | 04/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0325941 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0325941 | 01 | NY | NY STATE LICENSE NUMBER | OTHER |