Healthcare Provider Details

I. General information

NPI: 1619278678
Provider Name (Legal Business Name): CHELSEY BROWN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 S NEW BALLAS RD 200
SAINT LOUIS MO
63141-8704
US

IV. Provider business mailing address

763 S NEW BALLAS RD 200
SAINT LOUIS MO
63141-8704
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-2562
  • Fax: 314-991-2593
Mailing address:
  • Phone: 314-991-2562
  • Fax: 314-991-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number201021690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: