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General NPI Number Information
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NPI Number | 1639708142
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Entity Type | Individual
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Provider Name | EILEEN DIANE CAADAN CHAVEZ PT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 6170 JOLIET RD # I
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3976
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Country | US
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Telephone | 708-352-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 2241 DESPLAINES AVE APT 4
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1291
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Country | US
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Telephone | 224-325-6622
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070022710
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License Number State | IL
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