Provider Demographics
NPI:1649232588
Name:CHASAN, NEIL (PT, MMT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:CHASAN
Suffix:
Gender:M
Credentials:PT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 112TH AVE NE
Mailing Address - Street 2:SUITE D154
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-643-9778
Mailing Address - Fax:425-643-6448
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE D154
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-643-9778
Practice Address - Fax:425-643-6448
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0117299OtherLABOR & INDUSTRY
130784130786OtherPREMERA
4544276OtherAETNA
CH4792OtherREGENCE
CH4792OtherREGENCE
WAG8852333Medicare PIN