Provider Demographics
NPI:1649690561
Name:WEBB, CHANTZ (LMP)
Entity type:Individual
Prefix:
First Name:CHANTZ
Middle Name:
Last Name:WEBB
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MAPLE ST APT A202
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-7552
Mailing Address - Country:US
Mailing Address - Phone:509-433-1743
Mailing Address - Fax:
Practice Address - Street 1:1325 MAPLE ST APT A202
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-7552
Practice Address - Country:US
Practice Address - Phone:509-433-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60303771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist