Healthcare Provider Details

I. General information

NPI: 1407809569
Provider Name (Legal Business Name): KELLY S CHAVEZ-ALLEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KELLY S. CHAVEZ

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 S ASH AVE SUITE 102
TEMPE AZ
85282-6773
US

IV. Provider business mailing address

3830 E THUNDERHILL PL
PHOENIX AZ
85044-6678
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-4478
  • Fax: 480-838-7839
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: