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General NPI Number Information
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NPI Number | 1467018440
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Entity Type | Individual
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Provider Name | ELIE JOSEPH
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Gender | Male
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 1301 KANSAS AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-5921
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Country | US
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Telephone | 407-891-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 1156 ROAN CT
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City | KISSIMMEE
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State | FL
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Zip | 34759-7030
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Country | US
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Telephone | 407-953-5605
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA23831
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License Number State | FL
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