Healthcare Provider Details

I. General information

NPI: 1831149939
Provider Name (Legal Business Name): CHAD ANTHONY SEAHORN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/28/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 MELISSA LN
CARBONDALE CO
81623-2819
US

IV. Provider business mailing address

PO BOX 1012
CARBONDALE CO
81623-1012
US

V. Phone/Fax

Practice location:
  • Phone: 720-218-2731
  • Fax:
Mailing address:
  • Phone: 720-218-2731
  • Fax: 719-347-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 6868
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: