MEDICARE: CHARISSA LEE CHABAN MPT

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	2446	HI
2	225100000X	Physical Therapist	33494	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386748309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA LEE CHABAN MPT

Provider Business Mailing Address
First Line	:	2301 CAMINO RAMON STE 160
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2031
Country	:	US
Telephone Number	:	925-355-1900
Fax Number	:	925-355-1903

Provider Business Practice Location Address
First Line	:	2301 CAMINO RAMON STE 160
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2031
Country	:	US
Telephone Number	:	925-355-1900
Fax Number	:	925-355-1903

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	11/06/2019

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Directions to “ CHARISSA LEE CHABAN MPT” Practice Location

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