Provider Demographics
NPI:1063893691
Name:LAMOUR, CHANTELLE M (DPT, PT)
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:M
Last Name:LAMOUR
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:014-211-1253
Mailing Address - Fax:301-500-2175
Practice Address - Street 1:7080 DEEPAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5348
Practice Address - Country:US
Practice Address - Phone:410-381-7000
Practice Address - Fax:410-381-3779
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist