Provider Demographics
NPI:1295820207
Name:WISSLER, CHAD (PT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:WISSLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-6821
Mailing Address - Country:US
Mailing Address - Phone:617-777-2215
Mailing Address - Fax:
Practice Address - Street 1:176 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3126
Practice Address - Country:US
Practice Address - Phone:978-452-9252
Practice Address - Fax:978-970-0271
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68579OtherBLUE CROSS PROVIDER ID
MA479040OtherTUFTS PROVIDER ID
MAY68579OtherBLUE CROSS PROVIDER ID