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General NPI Number Information
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NPI Number | 1386356574
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Entity Type | Individual
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Provider Name | JUSTIN CHANDLER
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Gender | Male
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 5871 HARBOUR VIEW BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-3669
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Country | US
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Telephone | 757-512-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 205 WITTENHAM DR
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City | CARY
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State | NC
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Zip | 27519-5948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A7715
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP017149A
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License Number State | VA
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