Provider Demographics
NPI:1700402948
Name:ELJOR, MAYA TONY (CTRS)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:TONY
Last Name:ELJOR
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 GLENPARK CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3046
Mailing Address - Country:US
Mailing Address - Phone:804-218-2349
Mailing Address - Fax:
Practice Address - Street 1:13203 GLENPARK CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3046
Practice Address - Country:US
Practice Address - Phone:804-218-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist