Provider Demographics
NPI:1154641934
Name:NELLAS, ELEAZAR ELEGINO (PT)
Entity Type:Individual
Prefix:MR
First Name:ELEAZAR
Middle Name:ELEGINO
Last Name:NELLAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 TWILIGHT DR.
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450
Mailing Address - Country:US
Mailing Address - Phone:770-773-5123
Mailing Address - Fax:
Practice Address - Street 1:578 COMMERCIAL ST.
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341
Practice Address - Country:US
Practice Address - Phone:815-795-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist