Basic Information
| Provider Information | |||||||||
| NPI: | 1679852735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHACE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7516 NW 132ND ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731422405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054082160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7100 S I 35 SERVICE RD # 7 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731492740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056321002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4476 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.