Provider Demographics
NPI:1144486069
Name:FASBENDER-LOPEZ, CHANELLE L (DPT)
Entity type:Individual
Prefix:
First Name:CHANELLE
Middle Name:L
Last Name:FASBENDER-LOPEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHANELLE
Other - Middle Name:L
Other - Last Name:FASBENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:4505 LAS VIRGENES RD
Mailing Address - Street 2:SUITE 103-104
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-880-4758
Mailing Address - Fax:818-880-4781
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:SUITE 103-104
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-880-4758
Practice Address - Fax:818-880-4781
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist