Provider Demographics
NPI:1326866583
Name:GARLAND, CHELSEA (LMT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:GARLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S MOUNTAIN VIEW RD APT F5
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4510
Mailing Address - Country:US
Mailing Address - Phone:805-245-1569
Mailing Address - Fax:
Practice Address - Street 1:116 E 3RD ST STE AND212
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4318
Practice Address - Country:US
Practice Address - Phone:208-610-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6461878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist