Provider Demographics
NPI:1396141263
Name:FELDBRUGGE, CHASE MARTIN (ATC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:MARTIN
Last Name:FELDBRUGGE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PARK AVE
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-8050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-8050
Practice Address - Country:US
Practice Address - Phone:757-823-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260022352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer