Provider Demographics
NPI:1548757321
Name:CHRONISTER, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:CHRONISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BROADHEAD AVE APT A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-2864
Mailing Address - Country:US
Mailing Address - Phone:412-596-6904
Mailing Address - Fax:
Practice Address - Street 1:500 PROVIDENCE POINT BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1075
Practice Address - Country:US
Practice Address - Phone:412-489-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist