=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174082440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA MCELROY HUGGINS LPTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2019
-----------------------------------------------------
Last Update Date | 03/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 MIDDLETON RD # 600
-----------------------------------------------------
City | WINONA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38967-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-283-1260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4475 COUNTY ROAD 87
-----------------------------------------------------
City | VAIDEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39176-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-466-1467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA6613
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------