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General NPI Number Information
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NPI Number | 1558835611
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Entity Type | Individual
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Provider Name | CHASE MARK HARBACH PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 957 FAULKNER RD STE 105
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City | SANTA PAULA
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State | CA
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Zip | 93060-9129
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Country | US
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Telephone | 805-765-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 INSPIRATION DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-3306
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Country | US
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Telephone | 719-290-3310
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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 | 0015939
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60916535
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1311120
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 296653
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License Number State | CA
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