Provider Demographics
NPI:1922449255
Name:EBERT, CHANEL IRENE MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:IRENE MARIE
Last Name:EBERT
Suffix:
Gender:F
Credentials:PT, DPT
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 924
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0924
Mailing Address - Country:US
Mailing Address - Phone:785-456-4582
Mailing Address - Fax:
Practice Address - Street 1:24413 W WILLOW CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688
Practice Address - Country:US
Practice Address - Phone:785-456-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK188490225100000X
CAPT41213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist