Provider Demographics
NPI:1225458326
Name:MITCHELL, CHELSEA J (LMT, NMT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 GREAT NORTHERN LOOP
Mailing Address - Street 2:SUITE B2
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1750
Mailing Address - Country:US
Mailing Address - Phone:406-531-3078
Mailing Address - Fax:
Practice Address - Street 1:2819 GREAT NORTHERN LOOP
Practice Address - Street 2:SUITE B2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1750
Practice Address - Country:US
Practice Address - Phone:406-531-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-5907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT812053921OtherEIN