Provider Demographics
NPI:1558044958
Name:WATTENBARGER, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:WATTENBARGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2912
Mailing Address - Country:US
Mailing Address - Phone:812-701-4418
Mailing Address - Fax:
Practice Address - Street 1:130 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2912
Practice Address - Country:US
Practice Address - Phone:812-701-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist