MEDICARE: DANICA LEIGH ELGIN PT, DPT

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	225100000X	Physical Therapist	62905	OR

General Provider Information

NPI Number	:	1710454756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANICA LEIGH ELGIN PT, DPT

Provider Business Mailing Address
First Line	:	625 KENMOOR AVE SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2395
Country	:	US
Telephone Number	:	616-483-3480
Fax Number	:	616-356-5001

Provider Business Practice Location Address
First Line	:	4140 N WILLIAMS AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2948
Country	:	US
Telephone Number	:	971-347-1774
Fax Number	:	971-279-7849

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	03/10/2026

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