Provider Demographics
NPI:1689048506
Name:CHAVEZ, ELENA (LMT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NW 6TH ST UNIT 120
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4021
Mailing Address - Country:US
Mailing Address - Phone:510-612-5544
Mailing Address - Fax:
Practice Address - Street 1:309 SW 16TH AVE APT 220
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8587
Practice Address - Country:US
Practice Address - Phone:510-612-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist