MEDICARE: NICHOLAS CHAVIS

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	PT 31166	FL

General Provider Information

NPI Number	:	1710347174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS CHAVIS

Provider Business Mailing Address
First Line	:	4440 OAK BAY DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 OAK BAY DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1015
Country	:	US
Telephone Number	:	904-504-1419
Fax Number	:

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

Provider Enumeration Date	:	02/28/2016
Last Update Date	:	02/28/2016

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Directions to “ NICHOLAS CHAVIS ” Practice Location

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