Active NPI
Serenity Marie Chandler, PTA
- Physical Therapy Assistant
- Wake Forest, NC
National Provider Identifier
1356855993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A5466
- Practice address
- 1151 S Main St
Wake Forest, NC 27587-9646 - Phone
- (919) 423-5677
- NPI assigned
- Nov 17, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A5466 | NC | Primary |
Addresses
Primary practice location
1151 S Main St
Wake Forest, NC 27587-9646
Mailing address
1812 Hillock Dr Unit G
Raleigh, NC 27612-4037
Phone (984) 218-8603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5466 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510876800000",
"number": "1356855993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1812 HILLOCK DR UNIT G",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276124037",
"telephone_number": "984-218-8603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1151 S MAIN ST",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275879646",
"telephone_number": "919-423-5677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANDLER",
"first_name": "SERENITY",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-17",
"last_updated": "2017-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "A5466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.