MEDICARE: MR. ERIC MICHAEL ELMORE P.T.

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	6034	AZ

General Provider Information

NPI Number	:	1831265057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MICHAEL ELMORE P.T.

Provider Business Mailing Address
First Line	:	3602 E GREENWAY RD
Second Line	:	#106
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4648
Country	:	US
Telephone Number	:	602-652-1112
Fax Number	:	602-652-1114

Provider Business Practice Location Address
First Line	:	3602 E GREENWAY RD
Second Line	:	#106
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4648
Country	:	US
Telephone Number	:	602-652-1112
Fax Number	:	602-652-1114

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	06/27/2012

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