Individual
JACOB A CHAVEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
901 N SANTA FE AVE, FOUNTAIN, CO 80817-1738
(719) 822-0550
Mailing address
1025 JACKSON ST, PUEBLO, CO 81004-2471
(719) 553-6949
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0015038
CO
Other
Enumeration date
11/06/2024
Last updated
11/06/2024
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