Provider Demographics
NPI:1184240418
Name:LIZOTTE, CHELSEA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:LIZOTTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MARIE
Other - Last Name:FULLERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:748 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:NH
Mailing Address - Zip Code:03585-6926
Mailing Address - Country:US
Mailing Address - Phone:603-991-5846
Mailing Address - Fax:
Practice Address - Street 1:91 COUNTRY VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3142
Practice Address - Country:US
Practice Address - Phone:603-788-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant