Provider Demographics
NPI:1538183652
Name:CHISAR, MICHAEL A CHISAR ANDREW (PT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:MICHAEL A CHISAR
Middle Name:ANDREW
Last Name:CHISAR
Suffix:
Gender:M
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PASO NOGAL CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1700
Mailing Address - Country:US
Mailing Address - Phone:925-827-3321
Mailing Address - Fax:
Practice Address - Street 1:53 PASO NOGAL CT
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1700
Practice Address - Country:US
Practice Address - Phone:925-827-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20103225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer