Provider Demographics
NPI:1902571771
Name:ROSS, ELIZABETH SHAFER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHAFER
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:COULTER
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-374-7288
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PL STE 501
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-409-9444
Practice Address - Fax:718-409-0236
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10847225100000X
CA304923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist