Individual
LIJU CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRT
Contact information
Practice address
313 PAR DR, PHILADELPHIA, PA 19115-1018
(267) 549-1171
Mailing address
313 PAR DR, PHILADELPHIA, PA 19115-1018
(267) 549-1171
Taxonomy
Speciality
Code
Description
License number
State
2278G1100X
General Care Certified Respiratory Therapist
Primary
YM013705
PA
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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