Provider Demographics
NPI:1174696561
Name:REED, CHAD EUGENE (PT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:EUGENE
Last Name:REED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 W TIPPERARY LN
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-4280
Mailing Address - Country:US
Mailing Address - Phone:480-650-5082
Mailing Address - Fax:
Practice Address - Street 1:5088 W TIPPERARY LN
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-4280
Practice Address - Country:US
Practice Address - Phone:480-650-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5233225100000X
CA25230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist