Provider Demographics
NPI:1558835611
Name:HARBACH, CHASE MARK (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:MARK
Last Name:HARBACH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 INSPIRATION DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3306
Mailing Address - Country:US
Mailing Address - Phone:719-290-3310
Mailing Address - Fax:
Practice Address - Street 1:957 FAULKNER RD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-9129
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015939225100000X
WA60916535225100000X
TX1311120225100000X
CA296653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist