Provider Demographics
NPI:1851881593
Name:SANDBERG, CHLOE ADELINE (PT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ADELINE
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5514
Mailing Address - Country:US
Mailing Address - Phone:701-751-0994
Mailing Address - Fax:701-751-1657
Practice Address - Street 1:207 W FRONT AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5514
Practice Address - Country:US
Practice Address - Phone:701-751-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist