Active NPI
Roddara Chau, PTA
- Physical Therapy Assistant
- Dekalb, IL
National Provider Identifier
1942879085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.008295
- Practice address
- 1212 S 2ND St
Dekalb, IL 60115-4435 - Phone
- (815) 758-8151
- NPI assigned
- Jun 23, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.008295 | IL | Primary |
Addresses
Primary practice location
1212 S 2ND St
Dekalb, IL 60115-4435
Mailing address
472 N Sugar Grove Pkwy
Suite F #107
Sugar Grove, IL 60554
Phone (630) 819-0086
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.008295 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1942879085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "472 N SUGAR GROVE PKWY",
"address_2": "SUITE F #107",
"city": "SUGAR GROVE",
"state": "IL",
"postal_code": "60554",
"telephone_number": "630-819-0086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 S 2ND ST",
"city": "DEKALB",
"state": "IL",
"postal_code": "601154435",
"telephone_number": "815-758-8151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAU",
"first_name": "RODDARA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-23",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.008295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.