Basic Information
| Provider Information | |||||||||
| NPI: | 1821579087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIDHISH CHANDRA | ||||||||
| FirstName: | FNU | ||||||||
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| OtherLastName: | CHANDRA | ||||||||
| OtherFirstName: | NIDHISH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17521 US HIGHWAY 69 S STE 120 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757035596 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1280 SETTLERS RDG | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750092282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723828600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2018 | ||||||||
| LastUpdateDate: | 08/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2133880 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.