Provider Demographics
NPI:1306134366
Name:HALLER, CHELSEA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICOLE
Last Name:HALLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5604 N.W. 41ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122
Mailing Address - Country:US
Mailing Address - Phone:405-495-3770
Mailing Address - Fax:
Practice Address - Street 1:5604 N.W. 41ST
Practice Address - Street 2:SUITE 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122
Practice Address - Country:US
Practice Address - Phone:405-495-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist