Provider Demographics
NPI:1205569654
Name:CHASE, PETRINA MAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:PETRINA
Middle Name:MAE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 S 245TH CT
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4156
Mailing Address - Country:US
Mailing Address - Phone:206-856-9843
Mailing Address - Fax:
Practice Address - Street 1:7200 S 180TH ST STE 101
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5548
Practice Address - Country:US
Practice Address - Phone:206-856-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60893043225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant