Basic Information
| Provider Information | |||||||||
| NPI: | 1063983823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHELF | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | LESLIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHELF | ||||||||
| OtherFirstName: | TREY | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2705 N LEBANON ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460528622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654858852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2485 E WABASH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460419400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654858100 | ||||||||
| FaxNumber: | 7654858118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2018 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05011730A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.