Provider Demographics
NPI:1396040457
Name:KROMHOUT, CHELSA DIANE (LMT)
Entity Type:Individual
Prefix:
First Name:CHELSA
Middle Name:DIANE
Last Name:KROMHOUT
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 1:3466 3RD ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-2021
Mailing Address - Country:US
Mailing Address - Phone:772-473-4607
Mailing Address - Fax:
Practice Address - Street 1:1125 12TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3791
Practice Address - Country:US
Practice Address - Phone:772-473-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 56172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist