Healthcare Provider Details

I. General information

NPI: 1699135111
Provider Name (Legal Business Name): DANIEL CHAVEZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5201
US

IV. Provider business mailing address

515 W CASTILLO AVE
BELEN NM
87002-3525
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-5122
  • Fax:
Mailing address:
  • Phone: 505-715-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1229
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: