Provider Demographics
NPI:1144776337
Name:DANISH, ELIZABETH (PT/DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DANISH
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 TERON TRCE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1609
Mailing Address - Country:US
Mailing Address - Phone:770-904-6009
Mailing Address - Fax:770-904-2357
Practice Address - Street 1:2089 TERON TRCE
Practice Address - Street 2:SUITE 120
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1609
Practice Address - Country:US
Practice Address - Phone:770-904-6009
Practice Address - Fax:770-904-2357
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist