Provider Demographics
NPI:1023271269
Name:CHANEY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:CHANEY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-373-5827
Mailing Address - Street 1:26045 SOTTERLEY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-2659
Mailing Address - Country:US
Mailing Address - Phone:301-373-5827
Mailing Address - Fax:301-373-5753
Practice Address - Street 1:26045 SOTTERLEY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-2659
Practice Address - Country:US
Practice Address - Phone:301-373-5827
Practice Address - Fax:301-373-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987000800Medicaid
MD53476701OtherBLUE CROSS BLUE SHIELD REGIONAL PROFESSIONAL NUMBER
MDS16758OtherUPIN
MD601566700OtherU. S. DEPARTMENT OF LABOR - FECA
MDN4190001OtherBLUE CROSS / BLUE SHIELD FEP
MD144035OtherMEDICARE PTAN
MDN419OtherBLUE CROSS BLUE SHIELD OF MARYLAND
MD=========OtherUNITED HEALTHCARE
MDS16758OtherUPIN