Provider Demographics
NPI:1386408557
Name:CHISENALL, CAMERON TRENT
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:TRENT
Last Name:CHISENALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-3000
Mailing Address - Country:US
Mailing Address - Phone:423-309-1712
Mailing Address - Fax:
Practice Address - Street 1:52 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7201
Practice Address - Country:US
Practice Address - Phone:256-400-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist