Healthcare Provider Details

I. General information

NPI: 1861129215
Provider Name (Legal Business Name): CHANDLER JAMES SHILEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5787 VINELAND RD STE 104
ORLANDO FL
32819-7806
US

IV. Provider business mailing address

622 ARBOR POINTE AVE
MINNEOLA FL
34715-6048
US

V. Phone/Fax

Practice location:
  • Phone: 407-354-3906
  • Fax: 407-354-3907
Mailing address:
  • Phone: 352-272-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: