Provider Demographics
NPI:1790418481
Name:HALSOR, CHELSEA LEE (PTA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEE
Last Name:HALSOR
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 1:173 NEWTON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8673
Mailing Address - Country:US
Mailing Address - Phone:570-709-9235
Mailing Address - Fax:
Practice Address - Street 1:173 NEWTON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8673
Practice Address - Country:US
Practice Address - Phone:570-709-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant