Provider Demographics
NPI:1285129437
Name:VETTER, CHELSIE (PT)
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:VETTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHELSIE
Other - Middle Name:
Other - Last Name:BREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10620 W 12TH AVE APT 222
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-7210
Mailing Address - Country:US
Mailing Address - Phone:509-499-8529
Mailing Address - Fax:
Practice Address - Street 1:2223 W WELLESLEY AVE STE D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5003
Practice Address - Country:US
Practice Address - Phone:509-323-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60828528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1285129437Medicaid