Provider Demographics
NPI:1093596306
Name:CHAVEZ, FE THERESE MARTINEZ (PT)
Entity Type:Individual
Prefix:
First Name:FE THERESE
Middle Name:MARTINEZ
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11617 GROSVENOR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3510
Mailing Address - Country:US
Mailing Address - Phone:347-844-3694
Mailing Address - Fax:
Practice Address - Street 1:4343 KISSENA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2914
Practice Address - Country:US
Practice Address - Phone:718-661-1710
Practice Address - Fax:718-886-6414
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist