Provider Demographics
NPI:1073891032
Name:CHANEY, TINA MARIE (PT, DPT, CMT, PRPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:PT, DPT, CMT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S NOLEN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8056
Mailing Address - Country:US
Mailing Address - Phone:817-410-7777
Mailing Address - Fax:817-410-9906
Practice Address - Street 1:300 S NOLEN DR
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8056
Practice Address - Country:US
Practice Address - Phone:817-410-7777
Practice Address - Fax:817-410-9906
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021959225100000X
KS11-04321225100000X
TX1265672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist