Healthcare Provider Details

I. General information

NPI: 1497998124
Provider Name (Legal Business Name): MONIKA CHACE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 30TH ST STE. 200
BOULDER CO
80301-1200
US

IV. Provider business mailing address

2600 30TH ST STE. 200
BOULDER CO
80301-1200
US

V. Phone/Fax

Practice location:
  • Phone: 303-545-5792
  • Fax: 303-545-0030
Mailing address:
  • Phone: 303-545-5792
  • Fax: 303-545-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3329
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: