Healthcare Provider Details

I. General information

NPI: 1144596297
Provider Name (Legal Business Name): CHASE BRUTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 WYOMING AVE
SAN ANGELO TX
76904-7152
US

IV. Provider business mailing address

1629 WYOMING AVE
SAN ANGELO TX
76904-7152
US

V. Phone/Fax

Practice location:
  • Phone: 325-212-0170
  • Fax:
Mailing address:
  • Phone: 325-212-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberATP50901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: