Provider Demographics
NPI:1629136114
Name:CHIVERS, DAWN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:CHIVERS
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 1:45 WILLOW ST
Mailing Address - Street 2:APT. 215
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1910
Mailing Address - Country:US
Mailing Address - Phone:413-455-2362
Mailing Address - Fax:
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-788-6195
Practice Address - Fax:413-788-0437
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist