MEDICARE: MAKAYLAH HEYWARD CHASE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P22143	NC

General Provider Information

NPI Number	:	1356893317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAYLAH HEYWARD CHASE PT, DPT

Provider Business Mailing Address
First Line	:	2300 GALLBERRY LN
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-0161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 PROSPERITY CHURCH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8117
Country	:	US
Telephone Number	:	704-686-7223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	12/08/2025

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