Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1386159895 |
---|---|
Provider Name | Teri Eldenburg |
First Address | Firestone, CO 80520-1035 |
Second Address | Firestone, CO 80520-1035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |