MEDICARE: MODESTO ALVIN CHUA CAMACHO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	019020	NY

General Provider Information

NPI Number	:	1033352182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MODESTO ALVIN CHUA CAMACHO PT

Provider Business Mailing Address
First Line	:	18726 87TH RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-2426
Country	:	US
Telephone Number	:	718-454-4315
Fax Number	:	718-454-4315

Provider Business Practice Location Address
First Line	:	18726 87TH RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-2426
Country	:	US
Telephone Number	:	718-454-4315
Fax Number	:	718-454-4315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2009
Last Update Date	:	05/02/2024

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