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General NPI Number Information
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NPI Number | 1265553408
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Entity Type | Organization
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Legal Business Name | CHANCE PHYSICAL THERAPY & FITNESS PC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1301 SE LYNN LANE
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City | IDABEL
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State | OK
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Zip | 74745-6845
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Country | US
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Telephone | 580-286-7848
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Fax | 580-286-7863
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Provider Business Mailing Address
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Address Line | 1301 SE LYNN LANE
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City | IDABEL
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State | OK
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Zip | 74745-6845
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Country | US
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Telephone | 580-286-7848
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Fax | 580-286-7863
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | CHANCE CHETTA SAELIM
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Credential |
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Telephone | 580-286-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT2130
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License Number State | OK
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