Provider Demographics
NPI:1912755331
Name:QUALLS, CHELSEA BROOKE
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BROOKE
Last Name:QUALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 FLURRY RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:AR
Mailing Address - Zip Code:72835-9317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:794 FLURRY RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:AR
Practice Address - Zip Code:72835-9317
Practice Address - Country:US
Practice Address - Phone:870-490-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4204225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant