Provider Demographics
NPI:1023486024
Name:CHASE, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 N 700 E
Mailing Address - Street 2:APT 14
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6921
Mailing Address - Country:US
Mailing Address - Phone:208-631-7498
Mailing Address - Fax:
Practice Address - Street 1:659 N 700 E
Practice Address - Street 2:APT 14
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6921
Practice Address - Country:US
Practice Address - Phone:208-631-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer