MEDICARE: MISS EMILY RUTH ELLIOTT B.S., LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	08204	OH

General Provider Information

NPI Number	:	1699037127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY RUTH ELLIOTT B.S., LPTA

Provider Business Mailing Address
First Line	:	378 SCURLOCK RD
Second Line	:
City	:	PATRIOT
State	:	OH
Zip	:	45658-9327
Country	:	US
Telephone Number	:	740-339-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 COLUMBUS RD
Second Line	:	SUITE 203
City	:	ATHENS
State	:	OH
Zip	:	45701-1300
Country	:	US
Telephone Number	:	740-249-4081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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