Provider Demographics
NPI:1629848460
Name:FOURNIER, CHELSEA GABRIELLE (LPTA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:GABRIELLE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 WOODCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA MI 49707
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-464-0881
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH ST W
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9161
Practice Address - Country:US
Practice Address - Phone:989-362-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005034225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant