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Individual

RICHARD CHAMORRO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
33-06 ROSALIE ST, FAIR LAWN, NJ 07410-4736
(201) 232-8257
Mailing address
33-06 ROSALIE ST, FAIR LAWN, NJ 07410-4736
(201) 232-8257

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00189100
NJ
225200000X
Physical Therapy Assistant
48078
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
40QB00189100
PTA LICENSE
NJ
01
48078
PTA LICENSE
CA
Enumeration date
01/06/2023
Last updated
01/06/2023
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