Provider Demographics
NPI:1467707604
Name:CHIAVAROLI, SUSAN K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:CHIAVAROLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-1207
Mailing Address - Country:US
Mailing Address - Phone:781-878-6215
Mailing Address - Fax:
Practice Address - Street 1:804 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3055
Practice Address - Country:US
Practice Address - Phone:508-583-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant