Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1377 | AZ |
NPI | 1467523381 |
---|---|
Provider Name | Mr. Richard Charles Elsner |
First Address | Phoenix, AZ 85016-4872 |
Second Address | Phoenix, AZ 85016-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 27/05/2009 |