Provider Demographics
NPI:1386427110
Name:MATA, ANGELI JUSTINE CHAVEZ
Entity type:Individual
Prefix:
First Name:ANGELI JUSTINE
Middle Name:CHAVEZ
Last Name:MATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 S RICHFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5271
Mailing Address - Country:US
Mailing Address - Phone:303-668-2237
Mailing Address - Fax:
Practice Address - Street 1:422 N NORTHWEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3273
Practice Address - Country:US
Practice Address - Phone:847-384-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist