Provider Demographics
NPI:1992399950
Name:CHUA, ROBERTO S (PT)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:S
Last Name:CHUA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GREENLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3441
Mailing Address - Country:US
Mailing Address - Phone:214-803-7856
Mailing Address - Fax:
Practice Address - Street 1:1301 GREENLEAF CIR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3441
Practice Address - Country:US
Practice Address - Phone:214-803-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist