Healthcare Provider Details

I. General information

NPI: 1952408296
Provider Name (Legal Business Name): RODOLFO CHUA JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HIGH MOUNTAIN RD
NORTH HALEDON NJ
07508-2662
US

IV. Provider business mailing address

506 SPENCER DR
WYCKOFF NJ
07481-2925
US

V. Phone/Fax

Practice location:
  • Phone: 973-949-3657
  • Fax: 973-949-3658
Mailing address:
  • Phone: 201-757-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA010597
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA010597
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: