Healthcare Provider Details

I. General information

NPI: 1376258616
Provider Name (Legal Business Name): JAYDE CHUCKALOVCHAK LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

45 RUTH ST APT 2
PITTSBURGH PA
15211-2055
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-2345
  • Fax:
Mailing address:
  • Phone: 330-418-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: