MEDICARE: NEIL CHASAN P.T., M.M.T.

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	PT00002855	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0117299	OTHER	WA	LABOR & INDUSTRY
2	130784130786	OTHER		PREMERA
3	4544276	OTHER		AETNA
4	CH4792	OTHER		REGENCE

General Provider Information

NPI Number	:	1649232588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL CHASAN P.T., M.M.T.

Provider Business Mailing Address
First Line	:	1750 112TH AVE NE
Second Line	:	SUITE D154
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3752
Country	:	US
Telephone Number	:	425-643-9778
Fax Number	:	425-643-6448

Provider Business Practice Location Address
First Line	:	1750 112TH AVE NE
Second Line	:	SUITE D154
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3752
Country	:	US
Telephone Number	:	425-643-9778
Fax Number	:	425-643-6448

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	11/18/2019

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