Provider Demographics
NPI:1700829066
Name:CHANDONNET, THEODORE R JR (MPT)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:R
Last Name:CHANDONNET
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 KOSCIUSZKO ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1608
Mailing Address - Country:US
Mailing Address - Phone:603-668-1106
Mailing Address - Fax:603-668-6533
Practice Address - Street 1:29 KOSCIUSZKO ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1608
Practice Address - Country:US
Practice Address - Phone:603-668-1106
Practice Address - Fax:603-668-6533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist