Provider Demographics
NPI:1083793707
Name:CHAPMAN AND DI REDO PARTNERSHIP
Entity Type:Organization
Organization Name:CHAPMAN AND DI REDO PARTNERSHIP
Other - Org Name:PARK AVENUE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:DI REDO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:209-723-8144
Mailing Address - Street 1:2808 PARK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3375
Mailing Address - Country:US
Mailing Address - Phone:209-723-8144
Mailing Address - Fax:209-723-5605
Practice Address - Street 1:2808 PARK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-723-8144
Practice Address - Fax:209-723-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT299911261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT70130Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CAR26705Medicare UPIN
CAQ337438Medicare UPIN
CA258642Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CAZZZ03732ZMedicare PIN
CA00PT67440Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CAP67075Medicare UPIN
CAR26725Medicare UPIN
CA0PT299911Medicare ID - Type UnspecifiedPHYSICAL THERAPY