Provider Demographics
NPI:1669837985
Name:CHASE, ANDREW JOSEPH (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:CHASE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 SHAWNEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-999-2030
Mailing Address - Fax:419-991-0909
Practice Address - Street 1:640 WORTH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8515
Practice Address - Country:US
Practice Address - Phone:814-664-9606
Practice Address - Fax:814-665-0036
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PATE1002979225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant