MEDICARE: KEVIN S ELO PT

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	05005012A	IN

General Provider Information

NPI Number	:	1801841630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S ELO PT

Provider Business Mailing Address
First Line	:	3673 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-533-5030
Fax Number	:	530-213-5970

Provider Business Practice Location Address
First Line	:	3673 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-533-5030
Fax Number	:	530-213-5970

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/09/2021

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Directions to “ KEVIN S ELO PT” Practice Location

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