Provider Demographics
NPI:1053813626
Name:DELK, ELIZABETH NICOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:DELK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-435-9008
Mailing Address - Fax:
Practice Address - Street 1:1534 DAWSON RD
Practice Address - Street 2:ALBANY THERAPEUTIC MASSAGE CLINIC
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-435-9008
Practice Address - Fax:229-435-9080
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist