Provider Demographics
NPI:1508918004
Name:LOVELACE-CHANDLER, VENITA (PHD, PT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:VENITA
Middle Name:
Last Name:LOVELACE-CHANDLER
Suffix:
Gender:F
Credentials:PHD, PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3655
Mailing Address - Country:US
Mailing Address - Phone:714-838-6999
Mailing Address - Fax:714-838-7099
Practice Address - Street 1:250 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3655
Practice Address - Country:US
Practice Address - Phone:714-838-6999
Practice Address - Fax:714-838-7099
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist