Provider Demographics
NPI:1962409581
Name:BACKUS, CHAD J (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:BACKUS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 STUART ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-6156
Mailing Address - Country:US
Mailing Address - Phone:775-625-2423
Mailing Address - Fax:775-625-2423
Practice Address - Street 1:1973 WHITWORTH WAY
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-2948
Practice Address - Country:US
Practice Address - Phone:775-625-2423
Practice Address - Fax:775-625-2423
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003407004Medicaid
NV003407004Medicaid