Provider Demographics
NPI:1700544764
Name:CHAD BACKUS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHAD BACKUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:775-304-1165
Mailing Address - Street 1:2826 STUART ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-6156
Mailing Address - Country:US
Mailing Address - Phone:775-304-1165
Mailing Address - Fax:
Practice Address - Street 1:2826 STUART ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-6156
Practice Address - Country:US
Practice Address - Phone:775-304-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty