Individual
CHANDRA WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
10800 MAGNOLIA AVE, RIVERSIDE, CA 92505-3043
(833) 574-2273
Mailing address
22750 SHADOWRIDGE LN, MORENO VALLEY, CA 92557-2632
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
10766
CA
225100000X
Physical Therapist
Primary
PT297188
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10766
PHYSICAL THERAPY ASSISTANT
CA
01
—
PT297188
PHYSICAL THERAPIST
CA
Enumeration date
05/11/2015
Last updated
01/04/2023
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