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General NPI Number Information
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NPI Number | 1336743475
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Entity Type | Individual
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Provider Name | ELI STROM MED, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 7801 N TIGERVILLE RD
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City | TIGERVILLE
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State | SC
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Zip | 29688-9700
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Country | US
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Telephone | 360-610-0486
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Fax |
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Provider Business Mailing Address
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Address Line | 2418 CROSBY DR
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City | MOUNT VERNON
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State | WA
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Zip | 98274-9077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | SC520357
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License Number State | SC
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