Provider Demographics
NPI:1942246152
Name:CHACON, VIRGINIA L (PT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:CHACON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:L
Other - Last Name:MENDIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6412 PINO REAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2926
Mailing Address - Country:US
Mailing Address - Phone:915-581-8434
Mailing Address - Fax:
Practice Address - Street 1:2900 PERSHING DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2403
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:915-566-3889
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83553EMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER