Basic Information
| Provider Information | |||||||||
| NPI: | 1356069801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CHANDLER | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 N 3RD ST APT 416 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191061223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179404516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 BRICK RD | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080532177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569888778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2022 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA02092600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.