| Doctor Name: | MS. GLORY CHACKO |
| NPI Number: | 1164523015 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 024995 |
| Business Practice Address: | 82-68 164th St Jamaica, NY - 114321121 |
| Business Phone Number: | 7188833225 |
| Business Fax Number: | 7188836193 |
| Mailing Address: | 79-01 Broadway, Managed Care, D1-01 ELMHURST |
| State: | NY |
| Postal Code: | 113731329 |
| Phone Number: | 7183341921 |
| Fax Number: | 7183343432 |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 024995 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |