Provider Demographics
NPI:1932311438
Name:CHAPPELL, LAURIE BETH (PTA)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:BETH
Last Name:CHAPPELL
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 1:2434 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060
Mailing Address - Country:US
Mailing Address - Phone:817-881-9388
Mailing Address - Fax:
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 104
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-882-9611
Practice Address - Fax:817-882-9976
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2032324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant