=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215282769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN CHASSE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1914 CENTRE ST
-----------------------------------------------------
City | WEST ROXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02132-2535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-323-8377
-----------------------------------------------------
Fax | 617-323-8077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 GRANITE ST STE 3
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-5350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-961-3370
-----------------------------------------------------
Fax | 781-961-1291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT32269
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 20071
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------