1457647786 NPI number — MISS CHELSEY HENSLEE FREED DPT

Table of content: MISS CHELSEY HENSLEE FREED DPT (NPI 1457647786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457647786 NPI number — MISS CHELSEY HENSLEE FREED DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREED
Provider First Name:
CHELSEY
Provider Middle Name:
HENSLEE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSLEE
Provider Other First Name:
CHELSEY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457647786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-407-3590
Provider Business Mailing Address Fax Number:
203-407-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2416 WHITNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-407-3590
Provider Business Practice Location Address Fax Number:
203-407-3595
Provider Enumeration Date:
06/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10664 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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