Provider Demographics
NPI:1417954652
Name:CHASE, KELLY MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3030 WESTCHESTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577
Mailing Address - Country:US
Mailing Address - Phone:914-682-6435
Mailing Address - Fax:914-681-3115
Practice Address - Street 1:3030 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2574
Practice Address - Country:US
Practice Address - Phone:914-682-6435
Practice Address - Fax:914-681-3115
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ34551OtherEMPIRE BC/BS
NYQ34551Medicare ID - Type Unspecified
NYQ34551OtherEMPIRE BC/BS