Provider Demographics
NPI:1740557123
Name:LAVELLE, CHELSEA ROSE (PT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSE
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:ROSE
Other - Last Name:VIZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8206 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4265
Mailing Address - Country:US
Mailing Address - Phone:612-805-3217
Mailing Address - Fax:
Practice Address - Street 1:123 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2301
Practice Address - Country:US
Practice Address - Phone:507-451-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist