Provider Demographics
NPI:1518623297
Name:CHAVEZ, KATHLEEN DOWNEY (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DOWNEY
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 1:29558 WOODBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4411
Mailing Address - Country:US
Mailing Address - Phone:818-991-6434
Mailing Address - Fax:
Practice Address - Street 1:401 RONEL CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3664
Practice Address - Country:US
Practice Address - Phone:805-375-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT94402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT9440OtherCALIFORNIA BOARD OF PHYSICAL THERAPY