Provider Demographics
NPI:1255686507
Name:REESE, CHELSEA R (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:R
Last Name:REESE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 BROOKSHIRE RD
Mailing Address - Street 2:APT. 7
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2620
Mailing Address - Country:US
Mailing Address - Phone:573-421-6077
Mailing Address - Fax:
Practice Address - Street 1:3866 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3710
Practice Address - Country:US
Practice Address - Phone:573-421-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22OtherMASSAGE THERAPY