Provider Demographics
NPI:1588552137
Name:BIANCONI, CHANCE CHRISMAN (DPT)
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:CHRISMAN
Last Name:BIANCONI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PROVIDENCE PKWY APT 7406
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2691
Mailing Address - Country:US
Mailing Address - Phone:228-238-9763
Mailing Address - Fax:
Practice Address - Street 1:840 N BLUEJAY WAY STE 107
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-5291
Practice Address - Country:US
Practice Address - Phone:615-989-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist