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General NPI Number Information
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NPI Number | 1811567183
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Entity Type | Individual
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Provider Name | ELISE DIANE FLANAGAN
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 512 NE 81ST ST STE H
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City | VANCOUVER
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State | WA
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Zip | 98665-8134
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Country | US
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Telephone | 360-553-3782
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Fax | 360-583-6191
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | WA
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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 |
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License Number State |
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