Provider Demographics
NPI:1184216996
Name:HILDRETH, ELIZABETH GARDNER (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GARDNER
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7002 EQUESTRIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9765
Mailing Address - Country:US
Mailing Address - Phone:336-580-4326
Mailing Address - Fax:
Practice Address - Street 1:1007 NC HIGHWAY 150 W STE D
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-7925
Practice Address - Country:US
Practice Address - Phone:336-643-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist