Provider Demographics
NPI:1003679788
Name:CANTLEY, COLTON CHASE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:CHASE
Last Name:CANTLEY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 TULIP TREE CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-7600
Mailing Address - Country:US
Mailing Address - Phone:740-525-5240
Mailing Address - Fax:
Practice Address - Street 1:379 OLD GREENVILLE HWY STE 101
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-3156
Practice Address - Country:US
Practice Address - Phone:864-624-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist