Provider Demographics
NPI:1124477971
Name:THOMAS, CHANDLER PAGE (PT)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:PAGE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8622 TAMARRON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1871
Mailing Address - Country:US
Mailing Address - Phone:980-269-1844
Mailing Address - Fax:980-580-7807
Practice Address - Street 1:13959 TOM SHORT RD
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-5300
Practice Address - Country:US
Practice Address - Phone:980-269-1844
Practice Address - Fax:980-580-7807
Is Sole Proprietor?:No
Enumeration Date:2016-06-11
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP16368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist