Provider Demographics
NPI:1407809569
Name:CHAVEZ-ALLEN, KELLY S (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:CHAVEZ-ALLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:S
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3830 E THUNDERHILL PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4930 S ASH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6773
Practice Address - Country:US
Practice Address - Phone:480-838-4478
Practice Address - Fax:480-838-7839
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4920680001Medicare NSC
AZ100425Medicare ID - Type Unspecified