Healthcare Provider Details

I. General information

NPI: 1174158398
Provider Name (Legal Business Name): CHASE MICHAEL CHERAMIE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18641 HIGHWAY 3235
GALLIANO LA
70354-3936
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 985-475-4555
  • Fax: 985-475-4557
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10627
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: