Healthcare Provider Details

I. General information

NPI: 1922461870
Provider Name (Legal Business Name): ELISSA DEUSNER PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 WINCHESTER RD N
SAINT PETERSBURG FL
33710-6314
US

IV. Provider business mailing address

1311 WINCHESTER RD N
SAINT PETERSBURG FL
33710-6314
US

V. Phone/Fax

Practice location:
  • Phone: 812-455-0627
  • Fax:
Mailing address:
  • Phone: 812-455-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: