1235763475 NPI number — CHELSIE MACONACHY PHYSICAL THERAPIST

Table of content: CHELSIE MACONACHY PHYSICAL THERAPIST (NPI 1235763475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235763475 NPI number — CHELSIE MACONACHY PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACONACHY
Provider First Name:
CHELSIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235763475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 YORK RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-1914
Provider Business Mailing Address Fax Number:
630-928-5014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7344 FODOR RD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43054-8336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-855-2570
Provider Business Practice Location Address Fax Number:
614-855-2580
Provider Enumeration Date:
02/26/2020

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

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





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