Provider Demographics
NPI:1750819405
Name:CHANDLER, THERESA DEMPSEY (LMT, LE)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DEMPSEY
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4283 S SHAWNEE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-3148
Mailing Address - Country:US
Mailing Address - Phone:832-240-6766
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE C104
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2562
Practice Address - Country:US
Practice Address - Phone:720-255-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist