Provider Demographics
NPI:1023184587
Name:PELHAM B. CHASTANG
Entity type:Organization
Organization Name:PELHAM B. CHASTANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTYE
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:CHASTANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:251-937-7600
Mailing Address - Street 1:39821 DUFFEE LN
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-6877
Mailing Address - Country:US
Mailing Address - Phone:251-937-7600
Mailing Address - Fax:251-937-7653
Practice Address - Street 1:39821 DUFFEE LN
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-6877
Practice Address - Country:US
Practice Address - Phone:251-937-7600
Practice Address - Fax:251-937-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH27702251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527691OtherBC BS FACILITY PROVIDER