Provider Demographics
NPI:1720195787
Name:CHANDLER, JEFFREY A (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 WESTGATE CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2932
Mailing Address - Country:US
Mailing Address - Phone:336-331-3277
Mailing Address - Fax:336-331-3279
Practice Address - Street 1:1396 WESTGATE CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2932
Practice Address - Country:US
Practice Address - Phone:336-331-3277
Practice Address - Fax:336-331-3279
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2509750Medicare PIN