Provider Demographics
NPI:1215452727
Name:CROSS, CHANEL DIANE (ATC)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:DIANE
Last Name:CROSS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 E JAMESON RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3979
Mailing Address - Country:US
Mailing Address - Phone:919-862-4292
Mailing Address - Fax:
Practice Address - Street 1:2077 EASTHAVEN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3811
Practice Address - Country:US
Practice Address - Phone:919-862-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer