Provider Demographics
NPI:1033364989
Name:CHANTRY, LAURIE (PTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CHANTRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-1308
Mailing Address - Country:US
Mailing Address - Phone:607-724-8315
Mailing Address - Fax:
Practice Address - Street 1:1977 MARSHLAND RD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-1440
Practice Address - Country:US
Practice Address - Phone:607-689-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66 006437225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant