MEDICARE: CHANELLE WEBBER PTA

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	225200000X	Physical Therapy Assistant	PTA49523	CA

General Provider Information

NPI Number	:	1982478319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE WEBBER PTA

Provider Business Mailing Address
First Line	:	3070 MADISON ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2310
Country	:	US
Telephone Number	:	760-591-7750
Fax Number	:	760-471-5139

Provider Business Practice Location Address
First Line	:	850 MAIN ST
Second Line	:
City	:	RAMONA
State	:	CA
Zip	:	92065-1968
Country	:	US
Telephone Number	:	760-789-1424
Fax Number	:	760-789-1463

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

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “ CHANELLE WEBBER PTA” Practice Location

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