Provider Demographics
NPI:1891243531
Name:BERGHORN, CHELSEA (MS, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BERGHORN
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1175 WRIGHT BROTHERS AVE BLDG 4402
Practice Address - Street 2:
Practice Address - City:SEYMOUR JOHNSON A F B
Practice Address - State:NC
Practice Address - Zip Code:27531-2375
Practice Address - Country:US
Practice Address - Phone:423-599-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000026452255A2300X
2255A2300X
NC42332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer