Provider Demographics
NPI:1194138594
Name:CHAVEZ, JESUS (PTA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PRAIRIE KEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6713
Mailing Address - Country:US
Mailing Address - Phone:561-223-0986
Mailing Address - Fax:
Practice Address - Street 1:2000 PRAIRIE KEY RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6713
Practice Address - Country:US
Practice Address - Phone:561-223-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant