Provider Demographics
NPI:1396403366
Name:CHAMBLEE CONCIERGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHAMBLEE CONCIERGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:251-610-4779
Mailing Address - Street 1:420 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4001
Mailing Address - Country:US
Mailing Address - Phone:251-610-4779
Mailing Address - Fax:
Practice Address - Street 1:420 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4001
Practice Address - Country:US
Practice Address - Phone:251-610-4779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty