Provider Demographics
NPI:1285774224
Name:CHASE, LISA ALICE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ALICE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1431
Mailing Address - Country:US
Mailing Address - Phone:631-821-5334
Mailing Address - Fax:
Practice Address - Street 1:1227-2 MONTAULK HIGHWAY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013056-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist