Provider Demographics
NPI:1972296754
Name:CHRISLEY, THOMAS P (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CHRISLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RHL BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8273
Mailing Address - Country:US
Mailing Address - Phone:304-746-9200
Mailing Address - Fax:304-746-9202
Practice Address - Street 1:301 RHL BLVD
Practice Address - Street 2:STE 202
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8273
Practice Address - Country:US
Practice Address - Phone:304-746-9200
Practice Address - Fax:304-746-9202
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV4646208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation