Provider Demographics
NPI:1922657238
Name:SANDOVAL, CHLOE C (PT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:C
Last Name:SANDOVAL
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 1:77622 COUNTRY CLUB DR STE G
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0447
Mailing Address - Country:US
Mailing Address - Phone:760-345-3087
Mailing Address - Fax:760-345-6852
Practice Address - Street 1:77622 COUNTRY CLUB DR STE G
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0447
Practice Address - Country:US
Practice Address - Phone:760-345-3087
Practice Address - Fax:760-345-6852
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist