Provider Demographics
NPI:1306558887
Name:CHAPARRO, ANGEL L JR (PTA)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:L
Last Name:CHAPARRO
Suffix:JR
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 1:4682 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8515
Mailing Address - Country:US
Mailing Address - Phone:912-312-2097
Mailing Address - Fax:
Practice Address - Street 1:4682 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8515
Practice Address - Country:US
Practice Address - Phone:912-312-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002426208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation