Provider Demographics
NPI:1972668598
Name:CHAVEZ, LEOVARDO (MPT, DPT, ATC, DN)
Entity Type:Individual
Prefix:DR
First Name:LEOVARDO
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MPT, DPT, ATC, DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576751
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357
Mailing Address - Country:US
Mailing Address - Phone:209-524-7488
Mailing Address - Fax:209-522-7488
Practice Address - Street 1:4341 SPYRES WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9259
Practice Address - Country:US
Practice Address - Phone:209-524-7488
Practice Address - Fax:209-522-7488
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27941225100000X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32202ZMedicare ID - Type Unspecified
CAQ33696Medicare UPIN