MEDICARE: DR. LYDIA CHIKE 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
1	225100000X	Physical Therapist	1192760	TX

General Provider Information

NPI Number	:	1407132509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA CHIKE DPT

Provider Business Mailing Address
First Line	:	22763 114TH RD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1313
Country	:	US
Telephone Number	:	347-387-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	22763 114TH RD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1313
Country	:	US
Telephone Number	:	347-387-4328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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