Healthcare Provider Details

I. General information

NPI: 1093377996
Provider Name (Legal Business Name): AUSTYN CAITLYN CHAPPELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ANNA GOODE WAY
SUFFOLK VA
23434-9236
US

IV. Provider business mailing address

5835 MINERAL SPRING RD
SUFFOLK VA
23438-9462
US

V. Phone/Fax

Practice location:
  • Phone: 757-923-5500
  • Fax:
Mailing address:
  • Phone: 757-556-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605370
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: