Healthcare Provider Details

I. General information

NPI: 1740557123
Provider Name (Legal Business Name): CHELSEA ROSE LAVELLE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA ROSE VIZE PT

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 12TH AVE E
SHAKOPEE MN
55379-1955
US

IV. Provider business mailing address

13419 CARAMEL TRL
EDEN PRAIRIE MN
55346-3242
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5952
  • Fax:
Mailing address:
  • Phone: 612-805-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: