1740324599 NPI number — DR. TINU THOMAS CHACKO PT, DPT

Table of content: DR. TINU THOMAS CHACKO PT, DPT (NPI 1740324599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740324599 NPI number — DR. TINU THOMAS CHACKO PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHACKO
Provider First Name:
TINU
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740324599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W WALNUT HILL LN
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-2928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-756-9500
Provider Business Mailing Address Fax Number:
972-756-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W WALNUT HILL LN
Provider Second Line Business Practice Location Address:
SUITE- 240
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-492-3947
Provider Business Practice Location Address Fax Number:
972-506-3007
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1162450 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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