Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1194802223 |
---|---|
Provider Name | Mr. Dale Lawrence Chatham |
First Address | Slidell, LA 70461-1539 |
Second Address | New Orleans, LA 70112-1262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |