1265682702 NPI number — MS. JESSICA INGRID CHIOVARO PHYSICAL THERAPIST

Table of content: MS. JESSICA INGRID CHIOVARO PHYSICAL THERAPIST (NPI 1265682702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265682702 NPI number — MS. JESSICA INGRID CHIOVARO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIOVARO
Provider First Name:
JESSICA
Provider Middle Name:
INGRID
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
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:
1265682702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7340 S ALTON WAY
Provider Second Line Business Mailing Address:
STE 11-D
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-2323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-256-9738
Provider Business Mailing Address Fax Number:
702-242-5629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 N NELLIS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89110-5384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-459-4900
Provider Business Practice Location Address Fax Number:
702-459-8686
Provider Enumeration Date:
09/21/2008

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265682702 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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