MEDICARE: BRANDON J CHAVEZ DPT

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	LPT-033769	AZ

General Provider Information

NPI Number	:	1346082765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON J CHAVEZ DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	320 W BELL RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-3511
Country	:	US
Telephone Number	:	602-767-6690
Fax Number	:	602-491-0447

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

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	08/20/2024

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