Provider Demographics
NPI:1144668138
Name:ELLIOTT, EMILY R (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 N HERCULES AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4403
Mailing Address - Country:US
Mailing Address - Phone:727-797-8100
Mailing Address - Fax:727-797-8110
Practice Address - Street 1:1944 N HERCULES AVE STE C
Practice Address - Street 2:(727) 797-8100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4403
Practice Address - Country:US
Practice Address - Phone:727-797-8100
Practice Address - Fax:727-797-8110
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9610225100000X
FL29097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist