Provider Demographics
NPI:1902512932
Name:LOUTHAN, CHASE HARRISON (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:HARRISON
Last Name:LOUTHAN
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N CONDIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLONO
Mailing Address - State:IL
Mailing Address - Zip Code:61880-9014
Mailing Address - Country:US
Mailing Address - Phone:217-254-7283
Mailing Address - Fax:
Practice Address - Street 1:407 N CONDIT ST
Practice Address - Street 2:
Practice Address - City:TOLONO
Practice Address - State:IL
Practice Address - Zip Code:61880-9014
Practice Address - Country:US
Practice Address - Phone:217-254-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0045912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer