Provider Demographics
NPI:1831772888
Name:TAYLOR, CHELSEA (PTA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N HARDROAD
Mailing Address - Street 2:
Mailing Address - City:BENLD
Mailing Address - State:IL
Mailing Address - Zip Code:62009-1226
Mailing Address - Country:US
Mailing Address - Phone:217-720-3504
Mailing Address - Fax:
Practice Address - Street 1:604 N HARDROAD
Practice Address - Street 2:
Practice Address - City:BENLD
Practice Address - State:IL
Practice Address - Zip Code:62009-1226
Practice Address - Country:US
Practice Address - Phone:217-720-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006162225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant