1083793707 NPI number — CHAPMAN AND DI REDO PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083793707 NPI number — CHAPMAN AND DI REDO PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAPMAN AND DI REDO PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARK AVENUE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083793707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2808 PARK AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95348-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-723-8144
Provider Business Mailing Address Fax Number:
209-723-5605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2808 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95348-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-723-8144
Provider Business Practice Location Address Fax Number:
209-723-5605
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DI REDO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
NICOLAS
Authorized Official Title or Position:
PHYSICAL THERAPIST / OWNER
Authorized Official Telephone Number:
209-723-8144

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  0PT299911 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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