Provider Demographics
NPI:1346860913
Name:CHAVEZ, FRANCIS THOMAS MARTINEZ (PT)
Entity Type:Individual
Prefix:
First Name:FRANCIS THOMAS
Middle Name:MARTINEZ
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 DESPLAINES AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1291
Mailing Address - Country:US
Mailing Address - Phone:224-769-2624
Mailing Address - Fax:
Practice Address - Street 1:625 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1805
Practice Address - Country:US
Practice Address - Phone:708-848-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist