Healthcare Provider Details

I. General information

NPI: 1235342742
Provider Name (Legal Business Name): DOUGLAS W CHASE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 GRAND AVE #203
BILLINGS MT
59102-6546
US

IV. Provider business mailing address

3307 GRAND AVE #203
BILLINGS MT
59102-6546
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-9080
  • Fax: 406-655-9065
Mailing address:
  • Phone: 406-655-9080
  • Fax: 406-655-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1291
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: