Provider Demographics
NPI:1194320754
Name:CRISTOBAL, CARRIE MAE CHU (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARRIE MAE
Middle Name:CHU
Last Name:CRISTOBAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PEACH CREEK RD (PO BOX 414)
Mailing Address - Street 2:APT. 2
Mailing Address - City:PEACH CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25639
Mailing Address - Country:US
Mailing Address - Phone:681-222-4100
Mailing Address - Fax:
Practice Address - Street 1:26901 US HIGHWAY 119 N
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7520
Practice Address - Country:US
Practice Address - Phone:606-237-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist