Provider Demographics
NPI:1083174007
Name:ELMITT, TREVOR ROBERT (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:ROBERT
Last Name:ELMITT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S HIGHLAND ST APT 422
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1645
Mailing Address - Country:US
Mailing Address - Phone:515-314-6569
Mailing Address - Fax:
Practice Address - Street 1:1115 E GETWELL LOOP
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-4210
Practice Address - Country:US
Practice Address - Phone:901-678-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer