Provider Demographics
NPI:1487212338
Name:CHANDA, CLARA PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:PAIGE
Last Name:CHANDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:PAIGE
Other - Last Name:KINNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3100 NC 55 HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8427
Mailing Address - Country:US
Mailing Address - Phone:919-338-1522
Mailing Address - Fax:
Practice Address - Street 1:3100 NC 55 HWY STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8427
Practice Address - Country:US
Practice Address - Phone:919-338-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist