Provider Demographics
NPI:1821332784
Name:CHASE, RYAN THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:CHASE
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 W RIDGELY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5135
Practice Address - Country:US
Practice Address - Phone:443-921-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260930Y5FMedicare PIN