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General NPI Number Information
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NPI Number | 1588106785
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Entity Type | Individual
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Provider Name | CHELSEY BACA ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2016
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Last Update Date | 11/06/2016
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Provider Practice Location Address
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Address Line | 9126 W CAMELBACK RD
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City | GLENDALE
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State | AZ
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Zip | 85305-3116
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Country | US
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Telephone | 602-703-3194
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Fax |
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Provider Business Mailing Address
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Address Line | 17374 N 89TH AVE APT 1326
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City | PEORIA
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State | AZ
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Zip | 85382-8139
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Country | US
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Telephone | 602-703-3194
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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 | 2000022761
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License Number State | AZ
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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 | 1426
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License Number State | AZ
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