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General NPI Number Information
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NPI Number | 1275323693
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Entity Type | Individual
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Provider Name | STEVE SAMUEL CHACKO
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Gender |
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 4300 COTTON GIN RD
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City | FRISCO
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State | TX
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Zip | 75034-4480
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Country | US
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Telephone | 469-437-5045
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 MUSCOGEE TRL
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City | CARROLLTON
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State | TX
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Zip | 75010-1164
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Country | US
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Telephone | 214-529-8931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2187634
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License Number State | TX
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