Provider Demographics
NPI:1801072319
Name:DENISE CHYETTE, PHYSICAL THERAPIST, INC.
Entity type:Organization
Organization Name:DENISE CHYETTE, PHYSICAL THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-750-5216
Mailing Address - Street 1:1800 N SEPULVEDA BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2902
Mailing Address - Country:US
Mailing Address - Phone:310-750-5216
Mailing Address - Fax:310-882-6426
Practice Address - Street 1:1800 N SEPULVEDA BLVD # 200
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2902
Practice Address - Country:US
Practice Address - Phone:310-750-5216
Practice Address - Fax:310-882-6426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21784Medicare PIN