=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467464206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY SERVICES OF CHELSEA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 12/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 N MAIN ST
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-277-2468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8682 WALLINWOOD FARMS AVE
-----------------------------------------------------
City | JENISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49428-9419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-457-4891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. KATHY LOU CARRIER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 269-372-8483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501011355
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------