Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT19362 | FL |
NPI | 1386668069 |
---|---|
Provider Name | Tamara Elzey |
First Address | Chester, VA 23831-1808 |
Second Address | Fort Lee, VA 23801-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 30/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT19362 | PHYSICAL THERAPIST LICENSE (01) | FL |