Provider Demographics
NPI:1043811383
Name:ADAMS, CHANDLER HENRY (PTA)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:HENRY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 HICKORY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5613
Mailing Address - Country:US
Mailing Address - Phone:504-360-2584
Mailing Address - Fax:
Practice Address - Street 1:1827 HICKORY AVE STE B
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5613
Practice Address - Country:US
Practice Address - Phone:504-360-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10740225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant