Charles V Chavez I, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

4146 Issued in ID

Practice address

4200 6TH Ave SE
Lacey, WA 98503-1042

Phone

(800) 869-7062

NPI assigned

May 6, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health & Services Washington

  dba Providence SoundHomeCare and Hospice

  • Home Health Agency
  • Lacey, WA
  • NPI 1063415198
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1164279170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 6TH AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031042",
            "telephone_number": "800-869-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 6TH AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031042",
            "telephone_number": "800-869-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "CHARLES",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "9255",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "4146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Man Wah Mackie Chan, MD
• Tina Chance
• Jacqueline Chaney, LMHC, NCC, PHD
• Connie Chapman, LICSW
• Sherry A Chapman
• Nikolay Chekhovich
• Sharon Chen
• Sothyry CHI, LM, CPM
• Emma Chonzena
• Yen Vo Choum, PHARMD

• Physical Therapy Assistant in Lacey, WA
• Providers in Lacey, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.