Healthcare Provider Details

I. General information

NPI: 1851720171
Provider Name (Legal Business Name): CHELSEA BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA BRYAN CARLSON

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD # C-23
LAS VEGAS NV
89102-1942
US

IV. Provider business mailing address

31 HASSAYAMPA TRL
HENDERSON NV
89052-6668
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-682-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: