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General NPI Number Information
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NPI Number | 1477804052
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Entity Type | Organization
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Legal Business Name | ELLIOTT PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 518 VANDERBILT DR
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City | PLACENTIA
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State | CA
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Zip | 92870-5118
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Country | US
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Telephone | 714-404-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 518 VANDERBILT DR
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City | PLACENTIA
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State | CA
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Zip | 92870-5118
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Country | US
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Telephone | 714-404-9474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | COLLEEN ROSE ELLIOTT
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Credential | PT, DPT
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Telephone | 714-404-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT32490
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License Number State | CA
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