Provider Demographics
NPI:1760982201
Name:KISHLER, CHELSEA JENELLE (DPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JENELLE
Last Name:KISHLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:JENELLE
Other - Last Name:GARASCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:19629 LOCHMOOR ST
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1743
Mailing Address - Country:US
Mailing Address - Phone:517-881-9985
Mailing Address - Fax:
Practice Address - Street 1:19629 LOCHMOOR ST
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1743
Practice Address - Country:US
Practice Address - Phone:517-881-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist