Provider Demographics
NPI:1285975565
Name:CHANDLER, SUZANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 WOODLAND N
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-1415
Mailing Address - Country:US
Mailing Address - Phone:781-424-9390
Mailing Address - Fax:
Practice Address - Street 1:222 TONGASS DRIIVE
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7539
Practice Address - Country:US
Practice Address - Phone:907-966-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19882225100000X
AK130650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1688071Medicaid