Provider Demographics
NPI:1235146432
Name:SHRATTER, ELLIOT R (CMTPT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:R
Last Name:SHRATTER
Suffix:
Gender:M
Credentials:CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 GRIEGOS RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2837
Mailing Address - Country:US
Mailing Address - Phone:505-344-9269
Mailing Address - Fax:
Practice Address - Street 1:1306 RIO GRANDE NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2633
Practice Address - Country:US
Practice Address - Phone:505-265-4943
Practice Address - Fax:505-265-4986
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist