Provider Demographics
NPI:1235383407
Name:CHASSE, CHARLINE E
Entity Type:Individual
Prefix:MS
First Name:CHARLINE
Middle Name:E
Last Name:CHASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 ANN DR S
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5707
Mailing Address - Country:US
Mailing Address - Phone:516-223-4662
Mailing Address - Fax:
Practice Address - Street 1:72 ANN DR S
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5707
Practice Address - Country:US
Practice Address - Phone:516-223-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist