Provider Demographics
NPI:1497276737
Name:CHASE, JACOB RYAN (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:CHASE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15617 CABRILLO WAY
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6187
Mailing Address - Country:US
Mailing Address - Phone:815-409-1772
Mailing Address - Fax:
Practice Address - Street 1:801 W BIG BEAVER RD STE 300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4725
Practice Address - Country:US
Practice Address - Phone:815-409-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1290979225100000X
MI5501303407225100000X
NY052512225100000X
PAPT032657225100000X
IACP033169T225100000X
WICP033184T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist