Provider Demographics
NPI:1679054241
Name:HALFORD, CHAD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:HALFORD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 W SAW BLADE LN APT 304
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-0029
Mailing Address - Country:US
Mailing Address - Phone:720-254-3511
Mailing Address - Fax:
Practice Address - Street 1:4246 W SAW BLADE LN APT 304
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-0029
Practice Address - Country:US
Practice Address - Phone:720-254-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7752225100000X
FL339032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic