Provider Demographics
NPI:1467197285
Name:ZIEGLER, CHANCE LAWRENCE
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:LAWRENCE
Last Name:ZIEGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 E COCONINO ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3208
Mailing Address - Country:US
Mailing Address - Phone:330-321-8683
Mailing Address - Fax:
Practice Address - Street 1:5002 S MILL AVE STE 105
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6828
Practice Address - Country:US
Practice Address - Phone:602-512-8607
Practice Address - Fax:480-894-9576
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ330622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist