Provider Demographics
NPI:1225115140
Name:CHAMBLIN, ELISHEVA (PT)
Entity Type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:
Last Name:CHAMBLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ROUTE 72 W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2489
Mailing Address - Country:US
Mailing Address - Phone:609-489-0230
Mailing Address - Fax:609-489-0232
Practice Address - Street 1:1594 ROUTE 9
Practice Address - Street 2:UNIT 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-3280
Practice Address - Country:US
Practice Address - Phone:732-557-9319
Practice Address - Fax:732-557-9519
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00249900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077842Medicare ID - Type Unspecified