Healthcare Provider Details

I. General information

NPI: 1609305812
Provider Name (Legal Business Name): CHELSEA FREAD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA GLAUSE

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 E 45TH ST APT G2
KEARNEY NE
68847-4153
US

IV. Provider business mailing address

1319 E 45TH ST APT G2
KEARNEY NE
68847-4153
US

V. Phone/Fax

Practice location:
  • Phone: 308-390-8566
  • Fax: 308-398-5232
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3709
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: