Healthcare Provider Details

I. General information

NPI: 1689310807
Provider Name (Legal Business Name): CHASE CAMPBELL VAN CLEAVE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 VILLAGE LN STE 206
SOLVANG CA
93463-3223
US

IV. Provider business mailing address

2856 SANTA BARBARA AVE
LOS OLIVOS CA
93441-4557
US

V. Phone/Fax

Practice location:
  • Phone: 432-413-2192
  • Fax:
Mailing address:
  • Phone: 432-413-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: