Healthcare Provider Details

I. General information

NPI: 1376382275
Provider Name (Legal Business Name): VALERIE LYNN ELZORA AINSWORTH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 AIRPORT RD STE A
DESTIN FL
32541-2822
US

IV. Provider business mailing address

4320 COMMONS DR W UNIT 5313
DESTIN FL
32541-8660
US

V. Phone/Fax

Practice location:
  • Phone: 850-837-3349
  • Fax:
Mailing address:
  • Phone: 251-648-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT41636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: