Healthcare Provider Details

I. General information

NPI: 1770240327
Provider Name (Legal Business Name): ELISHA MARKS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

IV. Provider business mailing address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-6611
  • Fax:
Mailing address:
  • Phone: 302-629-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0011416
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: