Provider Demographics
NPI:1184165201
Name:MARCELLE, CHELSEA P (DPT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:P
Last Name:MARCELLE
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 1:6000 HILLANDALE DR
Mailing Address - Street 2:STE 145
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4840
Mailing Address - Country:US
Mailing Address - Phone:678-418-8072
Mailing Address - Fax:678-518-0137
Practice Address - Street 1:1333 WILLOW PASS RD STE 110
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5225
Practice Address - Country:US
Practice Address - Phone:192-567-6743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012768225100000X
CA294692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012768OtherPT LICENSE