Provider Demographics
NPI:1215910161
Name:TENNEY, CHAD JEFFREY (PT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JEFFREY
Last Name:TENNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 S 6150 W
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-6702
Mailing Address - Country:US
Mailing Address - Phone:801-985-1878
Mailing Address - Fax:801-689-0201
Practice Address - Street 1:3476 W 4600 S
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9203
Practice Address - Country:US
Practice Address - Phone:801-689-0200
Practice Address - Fax:801-689-0201
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4088225100000X
UT6109493-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6626Medicaid
UTD6626Medicaid