Provider Demographics
NPI:1376169011
Name:FRY, CHANDLER (DPT)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:
Other - Last Name:TARRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6470
Mailing Address - Country:US
Mailing Address - Phone:918-270-1378
Mailing Address - Fax:
Practice Address - Street 1:14890 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-3515
Practice Address - Country:US
Practice Address - Phone:405-390-1731
Practice Address - Fax:405-390-1981
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5829208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation