MEDICARE: DR. MARISSA CHESTER 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	2251P0200X	Pediatric Physical Therapist
2	225100000X	Physical Therapist	05013716A	IN

General Provider Information

NPI Number	:	1750905113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA CHESTER DPT

Provider Business Mailing Address
First Line	:	10970 N 600 E-1
Second Line	:
City	:	MONROEVILLE
State	:	IN
Zip	:	46773-9422
Country	:	US
Telephone Number	:	419-605-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3439 HOBSON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1617
Country	:	US
Telephone Number	:	260-373-7925
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	05/14/2024

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