Provider Demographics
NPI:1922750686
Name:CHANDLER, LE'ANDRA MONIQUE (PTA)
Entity Type:Individual
Prefix:
First Name:LE'ANDRA
Middle Name:MONIQUE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PTA
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 176
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74727-0176
Mailing Address - Country:US
Mailing Address - Phone:580-775-4573
Mailing Address - Fax:
Practice Address - Street 1:2900 STILLHOUSE RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2029
Practice Address - Country:US
Practice Address - Phone:903-785-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2064788225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant