Provider Demographics
NPI:1255612255
Name:CHELLIAN, STEPHEN RUBEN (RPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RUBEN
Last Name:CHELLIAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26105 REGENCY CLUB LN
Mailing Address - Street 2:APT #8
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-6271
Mailing Address - Country:US
Mailing Address - Phone:586-693-0211
Mailing Address - Fax:
Practice Address - Street 1:26105 REGENCY CLUB LN
Practice Address - Street 2:APT #8
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-6271
Practice Address - Country:US
Practice Address - Phone:586-693-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist