Provider Demographics
NPI:1588234884
Name:DECKERT, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:DECKERT
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 1:17300 N PERIMETER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6598
Mailing Address - Country:US
Mailing Address - Phone:602-734-1826
Mailing Address - Fax:602-734-1835
Practice Address - Street 1:17300 N PERIMETER DR STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6598
Practice Address - Country:US
Practice Address - Phone:602-734-1826
Practice Address - Fax:602-734-1835
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist