Provider Demographics
NPI:1467785105
Name:PREATOR, CHANDRA J (DPT)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:J
Last Name:PREATOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GREG KRUSCHEK AVE
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762
Mailing Address - Country:US
Mailing Address - Phone:907-443-3238
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 966
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-4513
Practice Address - Fax:907-443-7492
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-10534225100000X
AKPHYP2858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist