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General NPI Number Information
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NPI Number | 1285774224
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Entity Type | Individual
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Provider Name | LISA ALICE CHASE P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1227-2 MONTAULK HIGHWAY
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City | OAKDALE
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State | NY
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Zip | 11769
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Country | US
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Telephone | 631-218-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 31 BRIARCLIFF RD
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City | SHOREHAM
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State | NY
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Zip | 11786-1431
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Country | US
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Telephone | 631-821-5334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013056-1
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License Number State | NY
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