Healthcare Provider Details

I. General information

NPI: 1780509430
Provider Name (Legal Business Name): CHESCA-LUCK EVANGELISTA BRONO DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 OCEAN AVE FL 3
BROOKLYN NY
11229-4552
US

IV. Provider business mailing address

1711 60TH ST APT 2F
BROOKLYN NY
11204-2209
US

V. Phone/Fax

Practice location:
  • Phone: 347-720-7181
  • Fax:
Mailing address:
  • Phone: 347-720-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: