Provider Demographics
NPI:1477637072
Name:KATICH, CHASE (PT)
Entity Type:Individual
Prefix:MR
First Name:CHASE
Middle Name:
Last Name:KATICH
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 1:18122 SW LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7216
Mailing Address - Country:US
Mailing Address - Phone:503-639-2118
Mailing Address - Fax:503-639-7688
Practice Address - Street 1:18122 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7216
Practice Address - Country:US
Practice Address - Phone:503-639-2118
Practice Address - Fax:503-639-7688
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist