Provider Demographics
NPI:1164315610
Name:VANDIVER, CHELSEA MICHELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:MICHELLE
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4679 NORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3229
Mailing Address - Country:US
Mailing Address - Phone:214-500-9180
Mailing Address - Fax:
Practice Address - Street 1:1451 GREENS PRAIRIE RD W STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8794
Practice Address - Country:US
Practice Address - Phone:979-690-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1406728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist