Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305205259 | VA |
NPI | 1003099706 |
---|---|
Provider Name | Celso Chavez |
First Address | Virginia Beach, VA 23454-3976 |
Second Address | Virginia Beach, VA 23454-3976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 17/12/2007 |