Provider Demographics
NPI:1215243225
Name:CHAMBERS, CONNIE SUZZETTE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUZZETTE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:SUZZETTE
Other - Last Name:COLDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:201 S NORTHPARK LN
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-8426
Mailing Address - Country:US
Mailing Address - Phone:417-623-4313
Mailing Address - Fax:417-621-0129
Practice Address - Street 1:201 S NORTHPARK LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-8426
Practice Address - Country:US
Practice Address - Phone:417-623-4313
Practice Address - Fax:417-621-0129
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2003001372225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant