Provider Demographics
NPI:1669651014
Name:CHACON, REMMIE EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:REMMIE
Middle Name:EDWARD
Last Name:CHACON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-277-3686
Mailing Address - Fax:602-277-3676
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-277-3686
Practice Address - Fax:602-277-3676
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113264OtherMEDICARE GROUP
AZ286449Medicaid
AZ119206Medicare PIN
AZZ113264OtherMEDICARE GROUP
AZ286449Medicaid
1871652131Medicare NSC
1265647879Medicare NSC
1568521821Medicare NSC
1447465059Medicare NSC
1174738785Medicare NSC
AZP00452732Medicare PIN