1205038924 NPI number — MISS ELIZABETH ANN CHAFFIN PT, DPT, MS, ATC

Table of content: MISS ELIZABETH ANN CHAFFIN PT, DPT, MS, ATC (NPI 1205038924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205038924 NPI number — MISS ELIZABETH ANN CHAFFIN PT, DPT, MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAFFIN
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205038924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 BAY ST
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94123-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-269-5479
Provider Business Mailing Address Fax Number:
415-614-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 BAY ST
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94123-1861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-269-5479
Provider Business Practice Location Address Fax Number:
415-614-0853
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  19216 , 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)





Copyright © 2007-2025 www.npivalidator.com