Provider Demographics
NPI:1174008403
Name:CHAVEZ, ASHLEY A (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:247 COOLCREST DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2865
Mailing Address - Country:US
Mailing Address - Phone:916-300-4893
Mailing Address - Fax:
Practice Address - Street 1:4501 SAND CREEK RD FL 3
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8687
Practice Address - Country:US
Practice Address - Phone:925-813-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist