Provider Demographics
NPI:1649639345
Name:VAN VRANKEN, CHANDREE LEIGH (DPT)
Entity type:Individual
Prefix:MISS
First Name:CHANDREE
Middle Name:LEIGH
Last Name:VAN VRANKEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SWEETMILK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9100
Mailing Address - Country:US
Mailing Address - Phone:518-859-6344
Mailing Address - Fax:
Practice Address - Street 1:820 COTTAGE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2426
Practice Address - Country:US
Practice Address - Phone:518-859-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4048208100000X
NY039874-1208100000X
OR61547208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation