Provider Demographics
NPI:1699731380
Name:CHASE, PENELOPE L (PT)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:L
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 1:102 WYNDING WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WHEATFIELD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7673
Practice Address - Country:US
Practice Address - Phone:570-296-5911
Practice Address - Fax:570-296-5931
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083507Medicare Oscar/Certification