Provider Demographics
NPI:1396950333
Name:CHANEY, VICKIE LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:LYNN
Last Name:CHANEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2864
Mailing Address - Country:US
Mailing Address - Phone:630-773-0933
Mailing Address - Fax:
Practice Address - Street 1:774 WILLOW CT
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2864
Practice Address - Country:US
Practice Address - Phone:630-773-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist