Provider Demographics
NPI:1114267861
Name:CHAISON, MICHELLE (DPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CHAISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6235
Mailing Address - Country:US
Mailing Address - Phone:563-343-8106
Mailing Address - Fax:
Practice Address - Street 1:2490 HUNTER RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6235
Practice Address - Country:US
Practice Address - Phone:563-343-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010748A225100000X
TNPT0000009480225100000X
IA004715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist