Provider Demographics
NPI:1558638148
Name:CHANDROSS, DAVID (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHANDROSS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 ENCLAVE PKWY
Mailing Address - Street 2:# 6307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3671
Mailing Address - Country:US
Mailing Address - Phone:281-920-0591
Mailing Address - Fax:
Practice Address - Street 1:1815 ENCLAVE PKWY
Practice Address - Street 2:# 6307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3671
Practice Address - Country:US
Practice Address - Phone:281-920-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-26
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00608171100000X
TX2034759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558638148Medicare PIN