Healthcare Provider Details

I. General information

NPI: 1568047918
Provider Name (Legal Business Name): CHASE SCARCE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

IV. Provider business mailing address

1000 RIDGE CREST LN
MOUNT AIRY NC
27030-2457
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-4711
  • Fax:
Mailing address:
  • Phone: 336-786-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: