Provider Demographics
NPI:1316253644
Name:EGUE, CHUTEH (LMT)
Entity type:Individual
Prefix:
First Name:CHUTEH
Middle Name:
Last Name:EGUE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10728 TABOR DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4940
Mailing Address - Country:US
Mailing Address - Phone:813-531-2734
Mailing Address - Fax:
Practice Address - Street 1:2901 W BUSCH BLVD
Practice Address - Street 2:610
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4523
Practice Address - Country:US
Practice Address - Phone:813-935-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist