MEDICARE: CASSIE CHONKO PT, DPT

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	1305075	TX

General Provider Information

NPI Number	:	1699266858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE CHONKO PT, DPT

Provider Business Mailing Address
First Line	:	711 W 38TH ST STE G4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1134
Country	:	US
Telephone Number	:	512-257-2500
Fax Number	:	512-257-2504

Provider Business Practice Location Address
First Line	:	711 W 38TH ST STE G4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1134
Country	:	US
Telephone Number	:	512-257-2500
Fax Number	:	512-257-2504

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	01/31/2022

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