Provider Demographics
NPI:1679262521
Name:COLWELL, CHELSEA (PTA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:COLWELL
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 1:801 E BRIDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-6302
Mailing Address - Country:US
Mailing Address - Phone:812-707-9030
Mailing Address - Fax:
Practice Address - Street 1:326 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4618
Practice Address - Country:US
Practice Address - Phone:812-948-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCP021517A225200000X
IN06005959A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant