Provider Demographics
NPI:1477599710
Name:CHANDLER, ALBERT (PT, CPED)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 S 1300 E
Mailing Address - Street 2:#W200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3712
Mailing Address - Country:US
Mailing Address - Phone:801-572-0690
Mailing Address - Fax:801-572-0696
Practice Address - Street 1:6319 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-2107
Practice Address - Country:US
Practice Address - Phone:801-265-9339
Practice Address - Fax:801-277-7993
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104649-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT104649-2401OtherPROFESSIONAL LICENSE