Provider Demographics
NPI:1801818208
Name:CHUDLEIGH, DANIEL
Entity Type:Individual
Prefix:MRS
First Name:DANIEL
Middle Name:
Last Name:CHUDLEIGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1054
Mailing Address - Country:US
Mailing Address - Phone:541-889-2221
Mailing Address - Fax:541-889-3437
Practice Address - Street 1:2671 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1833
Practice Address - Country:US
Practice Address - Phone:541-889-2221
Practice Address - Fax:541-889-3437
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR132076Medicare ID - Type Unspecified