Provider Demographics
NPI:1386872968
Name:CHINN, NIJAH M (PT, MHA)
Entity type:Individual
Prefix:
First Name:NIJAH
Middle Name:M
Last Name:CHINN
Suffix:
Gender:F
Credentials:PT, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:300B TEMPLE LAKE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2973
Practice Address - Country:US
Practice Address - Phone:804-524-9036
Practice Address - Fax:804-524-9039
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192946OtherBCBS (PHYSICAL THERAPY)
VA1386872968Medicaid
VAP00726345OtherRAILROAD MEDICARE
VA4651942OtherAETNA
VA020148T54Medicare PIN
VA192946OtherBCBS (PHYSICAL THERAPY)