Provider Demographics
NPI:1518685858
Name:CHASSE, SAMANTHA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:CHASSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LANING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1603
Mailing Address - Country:US
Mailing Address - Phone:203-441-4261
Mailing Address - Fax:860-736-5013
Practice Address - Street 1:881 NEW HARWINTON RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5948
Practice Address - Country:US
Practice Address - Phone:860-482-0600
Practice Address - Fax:860-482-0601
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist