Healthcare Provider Details

I. General information

NPI: 1811940950
Provider Name (Legal Business Name): ANDREW T. ELTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 GULF OF MEXICO DR SUITE 204A
LONGBOAT KEY FL
34228-2070
US

IV. Provider business mailing address

5370 GULF OF MEXICO DR SUITE 204A
LONGBOAT KEY FL
34228-2070
US

V. Phone/Fax

Practice location:
  • Phone: 941-209-3999
  • Fax: 941-210-3235
Mailing address:
  • Phone: 941-209-3999
  • Fax: 941-210-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8568
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: