Provider Demographics
NPI:1336679653
Name:FALCONER, CHELSEA JEAN (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:JEAN
Last Name:FALCONER
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-9792
Mailing Address - Country:US
Mailing Address - Phone:815-713-8284
Mailing Address - Fax:
Practice Address - Street 1:1643 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1462
Practice Address - Country:US
Practice Address - Phone:815-977-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960038142255A2300X
IL070024395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer