Provider Demographics
NPI:1063068161
Name:JENNINGS, CHELSEA ANNE (DPT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANNE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8110
Mailing Address - Country:US
Mailing Address - Phone:253-227-6903
Mailing Address - Fax:
Practice Address - Street 1:14800 STARFIRE WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8502
Practice Address - Country:US
Practice Address - Phone:206-267-7811
Practice Address - Fax:206-267-7813
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT296670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60959022OtherPT LICENSE