Healthcare Provider Details

I. General information

NPI: 1992297162
Provider Name (Legal Business Name): CAL CHASE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 GRAND AVE STE 203
BILLINGS MT
59102-6551
US

IV. Provider business mailing address

3307 GRAND AVE STE 203
BILLINGS MT
59102-6551
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-9060
  • Fax:
Mailing address:
  • Phone: 406-655-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14982
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: