Provider Demographics
NPI:1659617397
Name:CHAVEZ, MARIA LUZ MEDINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA LUZ
Middle Name:MEDINA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:MEDINA
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:179 COMBS ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8429
Mailing Address - Country:US
Mailing Address - Phone:336-372-2441
Mailing Address - Fax:336-372-7755
Practice Address - Street 1:179 COMBS ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8429
Practice Address - Country:US
Practice Address - Phone:336-372-2441
Practice Address - Fax:336-372-7755
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist