Provider Demographics
NPI:1427530633
Name:CHESLER, CARRIE LEIGH (PTA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEIGH
Last Name:CHESLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 MAIZE RD APT 1108
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4965
Mailing Address - Country:US
Mailing Address - Phone:817-706-6262
Mailing Address - Fax:
Practice Address - Street 1:120 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-9639
Practice Address - Country:US
Practice Address - Phone:940-648-2731
Practice Address - Fax:940-648-3125
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2032613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant