MEDICARE: CHANDLER ENKEY

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	225200000X	Physical Therapy Assistant	3046	OK

General Provider Information

NPI Number	:	1952056384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDLER ENKEY

Provider Business Mailing Address
First Line	:	1214 N GREEN COUNTRY BLVD
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-2407
Country	:	US
Telephone Number	:	918-606-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-3734
Country	:	US
Telephone Number	:	539-367-4500
Fax Number	:

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

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	02/14/2022

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Directions to “ CHANDLER ENKEY ” Practice Location

Language	Start Address	Practice Location

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