Provider Demographics
NPI:1114976586
Name:BOWER, ELISSA MAZZA (DPT)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:MAZZA
Last Name:BOWER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 HAFNERS LNDG
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2773
Mailing Address - Country:US
Mailing Address - Phone:315-243-4662
Mailing Address - Fax:
Practice Address - Street 1:SYRACUSE VA MEDICAL CENTER
Practice Address - Street 2:800 IRVING AVENUE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-425-2684
Practice Address - Fax:315-425-2685
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027353-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist