Provider Demographics
NPI:1497889208
Name:CHANDAR, PERIASWAMY SUBASH (PT)
Entity Type:Individual
Prefix:MR
First Name:PERIASWAMY
Middle Name:SUBASH
Last Name:CHANDAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 WINKLER RD
Mailing Address - Street 2:UNIT # 4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7274
Mailing Address - Country:US
Mailing Address - Phone:239-437-6620
Mailing Address - Fax:239-437-6619
Practice Address - Street 1:6710 WINKLER RD
Practice Address - Street 2:UNIT # 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7274
Practice Address - Country:US
Practice Address - Phone:239-437-6620
Practice Address - Fax:239-437-6619
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0011706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY020XOtherBCBS
FLY020XOtherBCBS