Provider Demographics
NPI:1689838211
Name:CHAVEZ, MELISSA EILEEN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:EILEEN
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 MARY ROSE LN
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1539
Mailing Address - Country:US
Mailing Address - Phone:559-410-8492
Mailing Address - Fax:
Practice Address - Street 1:1489 W LACEY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5957
Practice Address - Country:US
Practice Address - Phone:559-585-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist