Provider Demographics
NPI:1871150094
Name:LOUIE, CHARISSA (DPT)
Entity type:Individual
Prefix:DR
First Name:CHARISSA
Middle Name:
Last Name:LOUIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 BERYL WAY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2983
Mailing Address - Country:US
Mailing Address - Phone:518-932-1498
Mailing Address - Fax:
Practice Address - Street 1:515 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3821
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0443042251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics