Provider Demographics
NPI:1073787560
Name:CHEVILLE, ROBERTA (PTA)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:CHEVILLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2725
Mailing Address - Country:US
Mailing Address - Phone:360-532-8788
Mailing Address - Fax:
Practice Address - Street 1:800 N MEDCALF LN
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-1318
Practice Address - Country:US
Practice Address - Phone:360-249-1606
Practice Address - Fax:360-249-2376
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant