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NPI Code Detail

MEDICARE: MS. KELLY MARIE CHASE PT

MEDICARE: MS. KELLY MARIE CHASE PT
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
1225100000XPhysical Therapist016759NY
2225100000XPhysical TherapistP23775NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q34551OTHERNYEMPIRE BC/BS

General Provider Information

NPI Number : 1417954652
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY MARIE CHASE PT
Provider Business Mailing Address
First Line : 3030 WESTCHESTER AVENUE
Second Line :
City : PURCHASE
State : NY
Zip : 10577
Country : US
Telephone Number : 914-682-6435
Fax Number : 914-681-3115
Provider Business Practice Location Address
First Line : 1211 VIRGINIA ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1313
Country : US
Telephone Number : 336-275-0927
Fax Number : 336-275-4834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 08/06/2025

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