Provider Demographics
NPI:1922622109
Name:CHAMBERLAND, SHAWNTEL (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:
First Name:SHAWNTEL
Middle Name:
Last Name:CHAMBERLAND
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3496
Mailing Address - Country:US
Mailing Address - Phone:903-675-8538
Mailing Address - Fax:
Practice Address - Street 1:313 WINDJAMMER RD
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5726
Practice Address - Country:US
Practice Address - Phone:972-921-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20772312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics