Provider Demographics
NPI:1689655078
Name:CHANDLER, TANZY L (DPT)
Entity Type:Individual
Prefix:
First Name:TANZY
Middle Name:L
Last Name:CHANDLER
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 1:9634 ELK GROVE FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2226
Mailing Address - Country:US
Mailing Address - Phone:916-685-8448
Mailing Address - Fax:
Practice Address - Street 1:9634 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2226
Practice Address - Country:US
Practice Address - Phone:916-685-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009822225100000X
CAPT 43014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8430688Medicaid