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General NPI Number Information
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NPI Number | 1881105757
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Entity Type | Individual
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Provider Name | ELISE CARLSON ATC/LAT, MS
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Gender | Female
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 3313 W HILLSBORO BLVD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-9423
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Country | US
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Telephone | 954-571-9500
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Fax | 561-955-2574
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Provider Business Mailing Address
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Address Line | 1103 SW 29TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-2909
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Country | US
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Telephone | 914-708-8980
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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 | AL2759
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License Number State | FL
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