Provider Demographics
NPI:1376243345
Name:PATE, CHANSARA
Entity Type:Individual
Prefix:
First Name:CHANSARA
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 US HIGHWAY 80 E APT 144
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5389
Mailing Address - Country:US
Mailing Address - Phone:469-445-7869
Mailing Address - Fax:
Practice Address - Street 1:2453 US HIGHWAY 80 E APT 144
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5389
Practice Address - Country:US
Practice Address - Phone:469-445-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer