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NPI Code Detail

MEDICARE: PRIYA A CHACKO DPT

MEDICARE: PRIYA A CHACKO DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070023432IL

General Provider Information

NPI Number : 1184138687
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRIYA A CHACKO DPT
Provider Business Mailing Address
First Line : 5520 LINCOLN AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3416
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5520 LINCOLN AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3416
Country : US
Telephone Number : 847-583-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 04/29/2020

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Directions to “ PRIYA A CHACKO DPT” Practice Location

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