Provider Demographics
NPI:1184390544
Name:LEVALLEY, CHANDLER LAUREN
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:LAUREN
Last Name:LEVALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13904 BELINDER ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3935
Mailing Address - Country:US
Mailing Address - Phone:913-237-2251
Mailing Address - Fax:
Practice Address - Street 1:4713 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1832
Practice Address - Country:US
Practice Address - Phone:913-237-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty