Provider Demographics
NPI:1053167064
Name:DE CHAINE, MARIE (PTLA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DE CHAINE
Suffix:
Gender:F
Credentials:PTLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 WOODBURY CT APT D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4321
Mailing Address - Country:US
Mailing Address - Phone:909-234-9203
Mailing Address - Fax:
Practice Address - Street 1:275 W HOSPITALITY LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3238
Practice Address - Country:US
Practice Address - Phone:909-567-2221
Practice Address - Fax:909-763-3216
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist