MEDICARE: CHANDLER RIEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070.026282	IL

General Provider Information

NPI Number	:	1003587536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDLER RIEM

Provider Business Mailing Address
First Line	:	300 W PAPERMILL RUN UNIT 202
Second Line	:
City	:	KIMBERLY
State	:	WI
Zip	:	54136-5507
Country	:	US
Telephone Number	:	618-694-6681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 N ENTERPRISE AVE
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-5491
Country	:	US
Telephone Number	:	920-560-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	05/09/2023

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Directions to “ CHANDLER RIEM ” Practice Location

Language	Start Address	Practice Location

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