Provider Demographics
NPI:1568987576
Name:HANES, CHELSEA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:HANES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 GREENBRIAR TOWNHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2426
Mailing Address - Country:US
Mailing Address - Phone:703-244-4303
Mailing Address - Fax:
Practice Address - Street 1:800 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-8489
Practice Address - Country:US
Practice Address - Phone:702-799-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260027422255A2300X
NV05064642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer