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NPI Code Detail

MEDICARE: TRACY LYNN CHUCK MSPT

MEDICARE:   TRACY LYNN CHUCK  MSPT
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
1225100000XPhysical TherapistPT26794CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10PT267940OTHERCAMEDICARE PTAN
2P00174988OTHERCAMEDICARE RAILROAD

General Provider Information

NPI Number : 1972587079
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LYNN CHUCK MSPT
Provider Business Mailing Address
First Line : 24630 WASHINGTON AVE
Second Line : STE 200
City : MURRIETA
State : CA
Zip : 92562-6177
Country : US
Telephone Number : 951-696-9353
Fax Number : 951-973-7216
Provider Business Practice Location Address
First Line : 73600 ALESSANDRO DR
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-3606
Country : US
Telephone Number : 760-674-0675
Fax Number : 760-674-0645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 09/17/2009

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Directions to “ TRACY LYNN CHUCK MSPT” Practice Location

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