Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1790093987 |
---|---|
Provider Name | Mr. Brady Benjamin Elliott |
First Address | Paradise, CA 95969 |
Second Address | Paradise, CA 95969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2010 |
Last Update Date | 08/12/2014 |