Provider Demographics
NPI:1780876110
Name:CHANDLER, STEPHEN M (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-8593
Mailing Address - Country:US
Mailing Address - Phone:785-742-7519
Mailing Address - Fax:
Practice Address - Street 1:511 PARAMOUNT ST
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534-2120
Practice Address - Country:US
Practice Address - Phone:785-284-3471
Practice Address - Fax:785-284-3697
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist