Provider Demographics
NPI:1255569919
Name:CHESSER, BRIANNA T (PT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:T
Last Name:CHESSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BUTTERNUT DR STE 8
Mailing Address - Street 2:PMB # 224
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1587
Mailing Address - Country:US
Mailing Address - Phone:616-510-1267
Mailing Address - Fax:616-399-4387
Practice Address - Street 1:520 BUTTERNUT DR STE 8
Practice Address - Street 2:PMB # 224
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1587
Practice Address - Country:US
Practice Address - Phone:616-510-1267
Practice Address - Fax:616-399-4387
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist