Provider Demographics
NPI:1235342742
Name:CHASE, DOUGLAS W (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:CHASE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 GRAND AVE
Mailing Address - Street 2:#203
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6546
Mailing Address - Country:US
Mailing Address - Phone:406-655-9080
Mailing Address - Fax:406-655-9065
Practice Address - Street 1:3307 GRAND AVE
Practice Address - Street 2:#203
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6546
Practice Address - Country:US
Practice Address - Phone:406-655-9080
Practice Address - Fax:406-655-9065
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401437Medicaid
MT1932396991OtherRAILROAD MEDICARE