MEDICARE: CHELSEA FENTON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	11632	CT
2	225100000X	Physical Therapist	PT014445	GA

General Provider Information

NPI Number	:	1689146755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA FENTON PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	5948 E LAKE PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4802
Country	:	US
Telephone Number	:	470-878-6059
Fax Number	:	470-878-6217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2018
Last Update Date	:	01/07/2020

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