MEDICARE: EMILY ELLIOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2003025416	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043351422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ELLIOTT

Provider Business Mailing Address
First Line	:	1625 GIBSON ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 GIBSON ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1873
Country	:	US
Telephone Number	:	417-255-9577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/06/2015

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Directions to “ EMILY ELLIOTT ” Practice Location

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