Provider Demographics
NPI:1538952452
Name:REID, ELISA P (ATC, PTA)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:P
Last Name:REID
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 ASHLAND MINE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9332
Mailing Address - Country:US
Mailing Address - Phone:720-582-8470
Mailing Address - Fax:
Practice Address - Street 1:101 S BARTLETT ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7217
Practice Address - Country:US
Practice Address - Phone:720-582-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0591023052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer