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General NPI Number Information
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NPI Number | 1366791485
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Entity Type | Individual
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Provider Name | CHAD EVAN HEARRELL LPTA
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Gender | Male
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 4686 E ASBURY CIR
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City | DENVER
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State | CO
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Zip | 80222-4723
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Country | US
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Telephone | 303-300-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 8380 W 63RD AVE
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City | ARVADA
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State | CO
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Zip | 80004-3418
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Country | US
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Telephone | 719-459-5467
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0012929
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License Number State | CO
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