Provider Demographics
NPI:1013424977
Name:CHAVEZ, KAREN VIVIANA
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:VIVIANA
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 1:6 CONCOURSE PKWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5359
Mailing Address - Country:US
Mailing Address - Phone:770-441-1580
Mailing Address - Fax:
Practice Address - Street 1:6 CONCOURSE PKWY STE 1100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5359
Practice Address - Country:US
Practice Address - Phone:770-441-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2135022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant