Individual
JESSE CHASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1404 LAWRENCEVILLE SUWANEE RD # A102, LAWRENCEVILLE, GA 30043-4331
(678) 749-0912
Mailing address
548 TRIP ST, GRAYSON, GA 30017-7860
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004639
GA
Other
Enumeration date
09/28/2022
Last updated
09/28/2022
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