Provider Demographics
NPI:1316753171
Name:VENEGAS, CHLOE LEE (DPT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:LEE
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 OSBORNE RD NE STE 280
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2866
Mailing Address - Country:US
Mailing Address - Phone:763-784-3155
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE STE 280
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2866
Practice Address - Country:US
Practice Address - Phone:763-784-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist