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NPI Code Detail

MEDICARE: MRS. DEBRA SUE CHANDLER PT

MEDICARE: MRS. DEBRA SUE CHANDLER PT
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
1225100000XPhysical Therapist01507MO

General Provider Information

NPI Number : 1588737522
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBRA SUE CHANDLER PT
Provider Business Mailing Address
First Line : 3815 MAGNOLIA AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-4025
Country : US
Telephone Number : 314-776-4320
Fax Number : 314-776-1875
Provider Business Practice Location Address
First Line : 3815 MAGNOLIA AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-4025
Country : US
Telephone Number : 314-776-4320
Fax Number : 314-776-1875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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