Healthcare Provider Details

I. General information

NPI: 1063181402
Provider Name (Legal Business Name): CHASE HSING CHAVEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MAPLE AVE STE 110
EVANSTON IL
60201-3134
US

IV. Provider business mailing address

1704 MAPLE AVE STE 110
EVANSTON IL
60201-3134
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 224-271-5556
Mailing address:
  • Phone: 630-933-1500
  • Fax: 224-271-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: