Provider Demographics
NPI:1043647266
Name:WALLEY, ELIZABETH TAYLOR (PT, DPT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TAYLOR
Last Name:WALLEY
Suffix:
Gender:F
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 ROSLYN ST UNIT 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3324
Mailing Address - Country:US
Mailing Address - Phone:720-848-9127
Mailing Address - Fax:720-848-9011
Practice Address - Street 1:3055 ROSLYN ST UNIT 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3324
Practice Address - Country:US
Practice Address - Phone:720-848-9127
Practice Address - Fax:720-848-9011
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10315225100000X
MA17344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist