Provider Demographics
NPI:1689207078
Name:CHASE, LORI CHANELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:CHANELLE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 N MCKINLEY DR
Mailing Address - Street 2:2306
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:301-346-4120
Mailing Address - Fax:
Practice Address - Street 1:129 S PEBBLE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5718
Practice Address - Country:US
Practice Address - Phone:813-633-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305292251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors