Provider Demographics
NPI:1417310996
Name:CHACON FIERRO, OVIDIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OVIDIA
Middle Name:
Last Name:CHACON FIERRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:OVIDIA
Other - Middle Name:
Other - Last Name:CHACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1712 S COUNTRY CLUB DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6046
Practice Address - Country:US
Practice Address - Phone:602-313-4337
Practice Address - Fax:480-222-1457
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12054PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist