Provider Demographics
NPI:1477298123
Name:MEAD, CHELSEA (PTA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 W WIGWAM BLVD UNIT 2223
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-6044
Mailing Address - Country:US
Mailing Address - Phone:517-206-3637
Mailing Address - Fax:
Practice Address - Street 1:19801 W FREMONT RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9512
Practice Address - Country:US
Practice Address - Phone:623-474-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ013824225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant