Individual
MS. CHINITA MAY PALLE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
351 S STRAITS HWY, INDIAN RIVER, MI 49749-9713
(941) 585-6386
Mailing address
PO BOX 829, INDIAN RIVER, MI 49749-0829
(941) 585-6386
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501012476
MI
225100000X
Physical Therapist
PT26834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14399334
CAQH PROVIDER ID
—
Enumeration date
11/16/2011
Last updated
06/11/2019
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