Basic Information
| Provider Information | |||||||||
| NPI: | 1649751561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAPA | ||||||||
| FirstName: | DONALD | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 S RED RIVER EXPY APT 411 | ||||||||
| Address2: | |||||||||
| City: | BURKBURNETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763543772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406558792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4511 CORONADO AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763102409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406928001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2067520 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.