Provider Demographics
NPI:1013378140
Name:CHASE, KIMBERLY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROCK HAVEN RD
Mailing Address - Street 2:APT B 204
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510
Mailing Address - Country:US
Mailing Address - Phone:360-689-2349
Mailing Address - Fax:
Practice Address - Street 1:JAMES A TAYLOR BUILDING
Practice Address - Street 2:UNC CHAPEL HILL CB#7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-966-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-24862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer