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General NPI Number Information
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NPI Number | 1538952452
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Entity Type | Individual
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Provider Name | ELISA P REID ATC, PTA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 101 S BARTLETT ST
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City | MEDFORD
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State | OR
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Zip | 97501-7217
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Country | US
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Telephone | 720-582-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 ASHLAND MINE RD
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City | ASHLAND
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State | OR
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Zip | 97520-9332
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Country | US
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Telephone | 720-582-8470
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 059102305
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License Number State | CO
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