MEDICARE: DR. ASHLEY SARA CHINNAN 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	023855-1	NY

General Provider Information

NPI Number	:	1053441758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY SARA CHINNAN PT

Provider Business Mailing Address
First Line	:	28 SOUTH COTTAGE STREET
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5918
Country	:	US
Telephone Number	:	516-837-0509
Fax Number	:	516-599-0856

Provider Business Practice Location Address
First Line	:	28 SOUTH COTTAGE STREET
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5918
Country	:	US
Telephone Number	:	516-837-0509
Fax Number	:	516-599-0856

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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