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General NPI Number Information
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NPI Number | 1477860146
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Entity Type | Individual
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Provider Name | CHELSEA MATTHEW ATC
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Gender | Female
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 1700 FULTON RD
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City | SANTA ROSA
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State | CA
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Zip | 95403-1899
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Country | US
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Telephone | 707-890-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 E TESCH AVE
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City | SAINT FRANCIS
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State | WI
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Zip | 53235-4765
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Country | US
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Telephone | 920-212-0580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1305-39
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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