Healthcare Provider Details

I. General information

NPI: 1942514575
Provider Name (Legal Business Name): ANNA M ELKINS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3846 WESTWOOD DR
RIVERSIDE CA
92504-2722
US

IV. Provider business mailing address

3846 WESTWOOD DR
RIVERSIDE CA
92504-2722
US

V. Phone/Fax

Practice location:
  • Phone: 951-809-1532
  • Fax: 951-729-5500
Mailing address:
  • Phone: 951-809-1532
  • Fax: 951-729-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 9255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: