Provider Demographics
NPI:1295096592
Name:CHAVIS, MARTINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:POLAKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 MANAWAI ST UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-356-0939
Mailing Address - Fax:808-356-0939
Practice Address - Street 1:458 MANAWAI ST UNIT 1203
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-367-0986
Practice Address - Fax:808-356-0939
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015900225100000X
HI3685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist