Provider Demographics
NPI:1558772616
Name:DENHERDER, CHANDRA PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:PAIGE
Last Name:DENHERDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 WHITEFISH STAGE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2753
Mailing Address - Country:US
Mailing Address - Phone:406-756-7878
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:8111 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3588
Practice Address - Country:US
Practice Address - Phone:406-420-2350
Practice Address - Fax:406-857-2996
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist