Individual
MR. CHARLES V CHAVEZ I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4200 6TH AVE SE, LACEY, WA 98503-1042
(800) 869-7062
Mailing address
4200 6TH AVE SE, LACEY, WA 98503-1042
(800) 869-7062
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4146
ID
225200000X
Physical Therapy Assistant
9255
OR
Other
Enumeration date
05/06/2024
Last updated
05/06/2024
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