Healthcare Provider Details

I. General information

NPI: 1972507515
Provider Name (Legal Business Name): TARIK RASHAD CHASE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARRY THOMAS WAY NE STE A
WASHINGTON DC
20002-4361
US

IV. Provider business mailing address

315 V ST NE
WASHINGTON DC
20002-1411
US

V. Phone/Fax

Practice location:
  • Phone: 202-481-2795
  • Fax: 202-481-2793
Mailing address:
  • Phone: 202-425-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT200001255
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20977
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: