Provider Demographics
NPI:1194802223
Name:CHATHAM, DALE LAWRENCE (KINESIOTHERAPIST)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:LAWRENCE
Last Name:CHATHAM
Suffix:
Gender:M
Credentials:KINESIOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1539
Mailing Address - Country:US
Mailing Address - Phone:985-643-5837
Mailing Address - Fax:
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1262
Practice Address - Country:US
Practice Address - Phone:504-568-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist