Provider Demographics
NPI:1740338847
Name:EDMONDS, CHANDI K (MPT, DPT)
Entity type:Individual
Prefix:MRS
First Name:CHANDI
Middle Name:K
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 E. CULLERTON
Mailing Address - Street 2:UNIT 1120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1498
Mailing Address - Country:US
Mailing Address - Phone:312-593-3915
Mailing Address - Fax:312-326-6009
Practice Address - Street 1:221 E. CULLERTON
Practice Address - Street 2:UNIT 1120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1498
Practice Address - Country:US
Practice Address - Phone:312-593-3915
Practice Address - Fax:312-326-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012346225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist