Provider Demographics
NPI:1114195138
Name:BOBROSKY, ELISHA (LMP)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:BOBROSKY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 1/2 WOODLAND PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6657
Mailing Address - Country:US
Mailing Address - Phone:206-755-8785
Mailing Address - Fax:
Practice Address - Street 1:7605 SE 27TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2835
Practice Address - Country:US
Practice Address - Phone:206-275-4870
Practice Address - Fax:206-275-4876
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023364172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist