Provider Demographics
NPI:1912753625
Name:CHAPMAN, BASCUM LEE III (PTA)
Entity Type:Individual
Prefix:
First Name:BASCUM
Middle Name:LEE
Last Name:CHAPMAN
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 COUNTY ROAD 3534
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:75478-3840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 COUNTY ROAD 3534
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:TX
Practice Address - Zip Code:75478
Practice Address - Country:US
Practice Address - Phone:903-243-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2118036225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant