Provider Demographics
NPI:1104175280
Name:PHILLIPS CLAYBROOK, CHELSEA BETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:BETH
Last Name:PHILLIPS CLAYBROOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SOUTH 74TH ST.
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904
Mailing Address - Country:US
Mailing Address - Phone:479-478-5577
Mailing Address - Fax:479-478-5560
Practice Address - Street 1:1801 SOUTH 74TH ST.
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904
Practice Address - Country:US
Practice Address - Phone:479-478-5577
Practice Address - Fax:479-478-5560
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant