Provider Demographics
NPI:1043983901
Name:VOS, ELYSSA G
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:G
Last Name:VOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELYSSA
Other - Middle Name:G
Other - Last Name:DEVRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 NEIGHBORHOOD MARKET RD STE 102&103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3525
Mailing Address - Country:US
Mailing Address - Phone:407-403-5822
Mailing Address - Fax:
Practice Address - Street 1:222 NEIGHBORHOOD MARKET RD STE 102&103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3525
Practice Address - Country:US
Practice Address - Phone:407-403-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X
FL31181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant