Provider Demographics
NPI:1104332758
Name:FETROW, CHLOE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:FETROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W GAY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2938
Mailing Address - Country:US
Mailing Address - Phone:267-576-2455
Mailing Address - Fax:
Practice Address - Street 1:117 W GAY ST STE 204
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2938
Practice Address - Country:US
Practice Address - Phone:267-576-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1004488225200000X
MSG014512225700000X
PAMSG014512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant