Basic Information
| Provider Information | |||||||||
| NPI: | 1174038632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORNHILL | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3208 GULF BREEZE PKWY | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325633350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006765130 | ||||||||
| FaxNumber: | 8889595753 | ||||||||
| Practice Location | |||||||||
| Address1: | 3208 GULF BREEZE PKWY | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325633350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006765130 | ||||||||
| FaxNumber: | 8889595753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2017 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106S00000X | RBT-18-53059 | Y |
No ID Information.