Provider Demographics
NPI:1366261158
Name:CARY, CHANCE W (PTA)
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:W
Last Name:CARY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 WHITE POST RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5455
Mailing Address - Country:US
Mailing Address - Phone:563-340-6385
Mailing Address - Fax:
Practice Address - Street 1:3150 GLENBROOK CIR S
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3656
Practice Address - Country:US
Practice Address - Phone:563-293-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122101225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant