Provider Demographics
NPI:1144790700
Name:BERDJIS, ELYSSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELYSSE
Middle Name:
Last Name:BERDJIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELYSSE
Other - Middle Name:
Other - Last Name:CURRERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3850 MIGHTY OAKS ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 MIGHTY OAKS ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7950
Practice Address - Country:US
Practice Address - Phone:949-422-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016513225100000X
CAPT295755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist