Healthcare Provider Details

I. General information

NPI: 1558772616
Provider Name (Legal Business Name): CHANDRA PAIGE DENHERDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 MT HIGHWAY 35
BIGFORK MT
59911-3588
US

IV. Provider business mailing address

1234 WHITEFISH STAGE
KALISPELL MT
59901-2753
US

V. Phone/Fax

Practice location:
  • Phone: 406-420-2350
  • Fax: 406-857-2996
Mailing address:
  • Phone: 406-756-7878
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60323
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: