Provider Demographics
NPI:1093050387
Name:DOWNS, ELIZA R (PT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:R
Last Name:DOWNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:R
Other - Last Name:BETTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:408 HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6135
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:2401 W TURNER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2182
Practice Address - Country:US
Practice Address - Phone:209-334-2224
Practice Address - Fax:209-334-2225
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU922ZMedicare PIN