Individual
CHRIS THEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2627 HYLAN BLVD STE A2, STATEN ISLAND, NY 10306-4344
(646) 820-5669
Mailing address
1785 FOREST AVE, STATEN ISLAND, NY 10303-2107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
044543
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044543
PT LICENSE
NY
Enumeration date
07/24/2020
Last updated
12/11/2023
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