Healthcare Provider Details

I. General information

NPI: 1578488508
Provider Name (Legal Business Name): MR. TIMOTHY CHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3056 S KINNICKINNIC AVE STE 302
MILWAUKEE WI
53207-1103
US

IV. Provider business mailing address

N83W13704 FOND DU LAC AVE APT 20
MENOMONEE FALLS WI
53051-7246
US

V. Phone/Fax

Practice location:
  • Phone: 414-326-2660
  • Fax:
Mailing address:
  • Phone: 414-839-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: