Basic Information
| Provider Information | |||||||||
| NPI: | 1922622109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERLAND | ||||||||
| FirstName: | SHAWNTEL | ||||||||
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| Credential: | PHYSICAL THERAPIST A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 LUCAS DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757513496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036758538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 313 WINDJAMMER RD | ||||||||
| Address2: | |||||||||
| City: | GUN BARREL CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751565726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729211692 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2020 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 2077231 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.