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General NPI Number Information
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NPI Number | 1336968452
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Entity Type | Individual
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Provider Name | CARLOS CHAVEZ PTA
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Gender | Male
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 500 E 51ST ST STE 1
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City | CHICAGO
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State | IL
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Zip | 60615-2494
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Country | US
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Telephone | 773-543-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 938 W 35TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-1513
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Country | US
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Telephone | 773-543-7450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.009228
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License Number State | IL
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