Provider Demographics
NPI:1346883626
Name:CONRAD, CHELSEA JO (LMT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JO
Last Name:CONRAD
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 1:1106 COLUMBIA AVE STE 151
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4347
Mailing Address - Country:US
Mailing Address - Phone:208-954-4542
Mailing Address - Fax:
Practice Address - Street 1:1106 COLUMBIA AVE STE 151
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4347
Practice Address - Country:US
Practice Address - Phone:208-954-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61008401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist