Provider Demographics
NPI:1881343549
Name:MONTELLO, CHELSEA E (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:MONTELLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:348 COOLEY ST UNIT 10
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1144
Practice Address - Country:US
Practice Address - Phone:413-355-5700
Practice Address - Fax:413-526-9961
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134389225100000X
MAPTL26957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist