Basic Information
| Provider Information | |||||||||
| NPI: | 1497093918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANCEY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6500 66TH ST N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337815030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273471286 | ||||||||
| FaxNumber: | 7273848224 | ||||||||
| Practice Location | |||||||||
| Address1: | 6500 66TH ST N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337815030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273471286 | ||||||||
| FaxNumber: | 7273848224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2013 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA912 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.