Provider Demographics
NPI:1215538707
Name:EGLOFF, ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EGLOFF
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 1:74 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2564 WALDEN AVE STE 105
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4759
Practice Address - Country:US
Practice Address - Phone:716-288-7427
Practice Address - Fax:716-288-7425
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP107430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist