MEDICARE: MR. JOSEPH MARIE ABANG CHAVEZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336396894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MARIE ABANG CHAVEZ PT

Provider Business Mailing Address
First Line	:	8813 RACHEL CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4558
Country	:	US
Telephone Number	:	410-988-5933
Fax Number	:

Provider Business Practice Location Address
First Line	:	8813 RACHEL CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4558
Country	:	US
Telephone Number	:	410-988-5933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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