Provider Demographics
NPI:1144556325
Name:CHANCE, KELLY DEANN (MPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DEANN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:MPT
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 248
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-0248
Mailing Address - Country:US
Mailing Address - Phone:361-798-3500
Mailing Address - Fax:361-238-5000
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2729
Practice Address - Country:US
Practice Address - Phone:361-798-3500
Practice Address - Fax:361-238-5000
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1150565OtherPHYSICAL THERAPY