Most Relevant Information
Provider Data
| NPI Number: | 1003811258 |
| Provider Name: | KELLEY NICOLE CHANDLER P.T. |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2002025550 |
Most Important Dates
| Enumeration Date: | 06/15/2005 |
| Last Updated: | 08/06/2010 |
Provider Practice Location
1420 W ASHLEY RD
BOONVILLE
MO
652332112
Practice Location Phone/Fax
| Phone: | 6608826115 |
| Fax: | 6608826120 |
Provider Mailing Location
4501 S HARVEST RD
COLUMBIA
MO
652038764
Provider Mailing Phone/Fax
| Phone: | 5734745098 |
| Fax: |