Provider Demographics
NPI:1679852735
Name:CHACE, BRIAN ALAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
Last Name:CHACE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2405
Mailing Address - Country:US
Mailing Address - Phone:405-408-2160
Mailing Address - Fax:
Practice Address - Street 1:7100 S I 35 SERVICE RD # 7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-2740
Practice Address - Country:US
Practice Address - Phone:405-632-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist