Provider Demographics
NPI:1952389488
Name:CHAVEZ, SANDRA K (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 SINGER BLVD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5846
Mailing Address - Country:US
Mailing Address - Phone:505-286-7838
Mailing Address - Fax:505-286-8025
Practice Address - Street 1:3901 SINGER BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5846
Practice Address - Country:US
Practice Address - Phone:505-286-7838
Practice Address - Fax:505-286-8025
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3099225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56421028Medicaid
NM348633807Medicare PIN