Provider Demographics
NPI:1023792645
Name:CORDELL, CHLOE NICHOLE (PT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:NICHOLE
Last Name:CORDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-1410
Mailing Address - Country:US
Mailing Address - Phone:337-703-3274
Mailing Address - Fax:337-703-3271
Practice Address - Street 1:4402 U S HIGHWAY 167 STE B
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-3708
Practice Address - Country:US
Practice Address - Phone:337-516-3160
Practice Address - Fax:337-516-3161
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11489OtherSTATE LICENSE