Provider Demographics
NPI:1497276737
Name:CHASE, JACOB RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:CHASE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:3267 BEE CAVES RD STE 126
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6774
Practice Address - Country:US
Practice Address - Phone:512-202-8634
Practice Address - Fax:512-961-8907
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1290979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist