Provider Demographics
NPI:1588622096
Name:CHASE, SANDRA JANELL (PT CPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JANELL
Last Name:CHASE
Suffix:
Gender:F
Credentials:PT CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 BENEDICT CT
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088
Mailing Address - Country:US
Mailing Address - Phone:972-412-7497
Mailing Address - Fax:
Practice Address - Street 1:8405 LAKEVIEW PARKWAY
Practice Address - Street 2:#204 CLAIR PHYSICAL THERAPY
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:214-607-4447
Practice Address - Fax:214-607-4839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8T4208 0063348OtherBCBS GROUP # 00U01X
5519029OtherAETNA
8T4208 0063348OtherBCBS GROUP # 00U01X