Healthcare Provider Details

I. General information

NPI: 1043596448
Provider Name (Legal Business Name): MARK ELIEFF PTA, MSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CHESTER AVE
BAKERSFIELD CA
93301-2014
US

IV. Provider business mailing address

4200 BOISE ST 22B
BAKERSFIELD CA
93306-1100
US

V. Phone/Fax

Practice location:
  • Phone: 661-395-3000
  • Fax:
Mailing address:
  • Phone: 661-872-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: