Healthcare Provider Details

I. General information

NPI: 1376459321
Provider Name (Legal Business Name): ELMER CHAVEZ-CASTREJON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NW GREENWOOD AVE
REDMOND OR
97756-1531
US

IV. Provider business mailing address

3195 NE DELMAS ST
BEND OR
97701-7709
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0410
  • Fax:
Mailing address:
  • Phone: 541-279-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66235
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: