Healthcare Provider Details

I. General information

NPI: 1265548549
Provider Name (Legal Business Name): AMY NOELLE ELLIOTT LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 E 29TH ST
LOVELAND CO
80538-2733
US

IV. Provider business mailing address

2917 ALAMOSA CT
LOVELAND CO
80538-2413
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3720
  • Fax: 970-667-7682
Mailing address:
  • Phone: 970-635-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: