Provider Demographics
NPI:1144569799
Name:ABAIR, CHAD B (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:B
Last Name:ABAIR
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 1:946 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2019
Mailing Address - Country:US
Mailing Address - Phone:574-876-0904
Mailing Address - Fax:
Practice Address - Street 1:2200 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5242
Practice Address - Country:US
Practice Address - Phone:765-289-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002961A225200000X
TX2093910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant