Organization
PELHAM B. CHASTANG
Active
Organization
PELHAM B. CHASTANG
Active
Other names
Buckaroo Barn, L. L. C.
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTYE HALL CHASTANG RPT (PHYSICAL THERAPIST)
(251) 937-7600
Entity
Organization
Contact information
Practice address
39821 DUFFEE LN, BAY MINETTE, AL 36507-6877
(251) 937-7600
(251) 937-7653
Mailing address
39821 DUFFEE LN, BAY MINETTE, AL 36507-6877
(251) 937-7600
(251) 937-7653
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PTH2770
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51527691
BC BS FACILITY PROVIDER
AL
Enumeration date
11/28/2006
Last updated
08/22/2020
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