Provider Demographics
NPI:1790275121
Name:BURDICK, CHELSEA L (DPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:BURDICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 WHITNEY RD W STE J
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1075
Mailing Address - Country:US
Mailing Address - Phone:585-300-4333
Mailing Address - Fax:585-454-8237
Practice Address - Street 1:650 WHITNEY RD W STE J
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1075
Practice Address - Country:US
Practice Address - Phone:585-300-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378392251X0800X
NY037-839261QP2000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy