Individual
ANSU SUSAN CHACKO
Active
Individual
ANSU SUSAN CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
034937
NY
225100000X
Physical Therapist
Primary
25062
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447657507
NPI
MD
05
—
4374045-00
—
MD
01
—
463684374
TAX ID
MD
Enumeration date
05/18/2012
Last updated
10/25/2016
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