Provider Demographics
NPI:1598220543
Name:WHITAKER, CHELSEA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3391
Mailing Address - Country:US
Mailing Address - Phone:707-344-1761
Mailing Address - Fax:
Practice Address - Street 1:1312 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3391
Practice Address - Country:US
Practice Address - Phone:707-344-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist