Provider Demographics
NPI:1831149939
Name:SEAHORN, CHAD ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ANTHONY
Last Name:SEAHORN
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:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1012
Mailing Address - Country:US
Mailing Address - Phone:720-218-2731
Mailing Address - Fax:719-347-9311
Practice Address - Street 1:868 MELISSA LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2819
Practice Address - Country:US
Practice Address - Phone:720-218-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 6868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO529038Medicare PIN