MEDICARE: ALBERT CHANDLER PT, CPED

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	104649-2401	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104649-2401	OTHER	UT	PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1477599710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT CHANDLER PT, CPED

Provider Business Mailing Address
First Line	:	9720 S 1300 E
Second Line	:	#W200
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-572-0690
Fax Number	:	801-572-0696

Provider Business Practice Location Address
First Line	:	6319 HIGHLAND DR
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-2107
Country	:	US
Telephone Number	:	801-265-9339
Fax Number	:	801-277-7993

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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