Provider Demographics
NPI:1023268224
Name:MIKKELSEN, CHANDIS (MSPT)
Entity type:Individual
Prefix:
First Name:CHANDIS
Middle Name:
Last Name:MIKKELSEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 E MISSION AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12509 E MISSION AVE
Practice Address - Street 2:STE. 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1049
Practice Address - Country:US
Practice Address - Phone:509-444-5678
Practice Address - Fax:509-343-5678
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist