Active NPI
Chase Gaston Haynie, PTA
- Physical Therapist
- Clarksdale, MS
National Provider Identifier
1972190346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTA-6504
- Practice address
- 1120 Ritchie Ave
Clarksdale, MS 38614-7535 - Phone
- (662) 621-1447
- NPI assigned
- Dec 30, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTA-6504 | MS | Primary |
Addresses
Primary practice location
1120 Ritchie Ave
Clarksdale, MS 38614-7535
Mailing address
71 Ridgecrest Dr
Pope, MS 38658-3150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-6504 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609286400000",
"number": "1972190346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 RIDGECREST DR",
"city": "POPE",
"state": "MS",
"postal_code": "386583150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 RITCHIE AVE",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386147535",
"telephone_number": "662-621-1447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNIE",
"first_name": "CHASE",
"middle_name": "GASTON",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-30",
"last_updated": "2020-12-30",
"certification_date": "2020-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PTA-6504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksdale, MS
- Valerie Hartsfield, RPH
- Katherine P Havens, M.ED.
- Brittany S Hawkins, LMSW, CMHT
- Erma Jean Hawkins, NURSE PRACTITIONER
- McCarley E Haynes, FNP
- Healing Hands Home Health
- Healing Hands Hospice and Sitting Service
- Helping Hearts Private Duty Nursing Service
- William D Henceroth II, MD
- Henderson Drugs, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.