Provider Demographics
NPI:1760981880
Name:CHETCHAVAT, CHARENA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHARENA
Middle Name:
Last Name:CHETCHAVAT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-853-3355
Mailing Address - Fax:
Practice Address - Street 1:795 EL CAMINO REAL FL 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-853-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-04
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist