Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2135022 | TX |
NPI | 1013424977 |
---|---|
Provider Name | Karen Viviana Chavez |
First Address | Atlanta, GA 30328-5359 |
Second Address | Atlanta, GA 30328-5359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2018 |
Last Update Date | 01/01/2018 |