Provider Demographics
NPI:1518468487
Name:RENDAHL, CHELSEA EDEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:EDEN
Last Name:RENDAHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13496 RUSSET LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4410
Mailing Address - Country:US
Mailing Address - Phone:858-805-5516
Mailing Address - Fax:
Practice Address - Street 1:1922 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-295-4175
Practice Address - Fax:760-295-4176
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist