Individual
JESSICA BROOKE CHAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
31 SHOVE ST, TIVERTON, RI 02878-1029
(401) 624-4743
(401) 624-9152
Mailing address
31 SHOVE ST, TIVERTON, RI 02878-1029
(401) 624-4743
(401) 624-9152
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT01579
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23335-8
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/24/2007
Last updated
07/24/2007
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