Provider Demographics
NPI:1184491664
Name:SHORT, CHASITY SUE
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:SUE
Last Name:SHORT
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 1:275 E MAIN ST HS2WC
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40621-0001
Mailing Address - Country:US
Mailing Address - Phone:502-564-3756
Mailing Address - Fax:
Practice Address - Street 1:275 E MAIN ST
Practice Address - Street 2:HS2W-C
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40621-0001
Practice Address - Country:US
Practice Address - Phone:877-417-8377
Practice Address - Fax:502-564-0329
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist