Healthcare Provider Details

I. General information

NPI: 1740369933
Provider Name (Legal Business Name): ELISA RABORN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S JEFFERSON ST
ABBEVILLE LA
70510-5906
US

IV. Provider business mailing address

509 KENSINGTON DR
LAFAYETTE LA
70508-7125
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-2899
  • Fax:
Mailing address:
  • Phone: 333-727-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00552
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: