Provider Demographics
NPI:1225280480
Name:CHASE, LAURA RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RENEE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 CAMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5423
Mailing Address - Country:US
Mailing Address - Phone:512-551-8994
Mailing Address - Fax:
Practice Address - Street 1:12710 RESEARCH BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4379
Practice Address - Country:US
Practice Address - Phone:512-892-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000151774225100000X
TX1188400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist