MEDICARE: TERESA CHAVEZ P.T.A

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	225200000X	Physical Therapy Assistant	06003661A	IN

General Provider Information

NPI Number	:	1508149592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA CHAVEZ P.T.A

Provider Business Mailing Address
First Line	:	925B WALNUT ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3609
Country	:	US
Telephone Number	:	502-641-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 QUARTERMASTER CT
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3670
Country	:	US
Telephone Number	:	812-284-3030
Fax Number	:

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/29/2011

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