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General NPI Number Information
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NPI Number | 1417799628
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Entity Type | Individual
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Provider Name | MARYA RAHAMTALLA ELASHA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/10/2024
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 107A AARON TIPPIN DR
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City | GREER
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State | SC
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Zip | 29650-1217
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Country | US
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Telephone | 864-416-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 107A AARON TIPPIN DR
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City | GREER
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State | SC
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Zip | 29650-1217
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Country | US
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Telephone | 864-652-5577
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP051638T
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305216543
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-6178
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License Number State | HI
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