Healthcare Provider Details

I. General information

NPI: 1376169011
Provider Name (Legal Business Name): CHANDLER FRY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDLER TARRANT

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14890 SE 29TH ST
CHOCTAW OK
73020-3515
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-1731
  • Fax: 405-390-1981
Mailing address:
  • Phone: 918-270-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5829
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: