Provider Demographics
NPI:1710343819
Name:CHESELDINE, COLLEEN ELIZABETH (ATC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:CHESELDINE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 S CAPITOL ST SW
Mailing Address - Street 2:#813
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3571
Mailing Address - Country:US
Mailing Address - Phone:301-266-3843
Mailing Address - Fax:
Practice Address - Street 1:1345 S CAPITOL ST SW
Practice Address - Street 2:#813
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3571
Practice Address - Country:US
Practice Address - Phone:301-266-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer