Healthcare Provider Details

I. General information

NPI: 1295939973
Provider Name (Legal Business Name): CHALITA LA SHON ROBERTS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 9TH AVENUE
PORT ARTHUR TX
77642
US

IV. Provider business mailing address

3611 JIMMY JOHNSON BLVD. #2008
PORT ARTHUR TX
77642
US

V. Phone/Fax

Practice location:
  • Phone: 409-722-2436
  • Fax:
Mailing address:
  • Phone: 409-729-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2046514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: