Provider Demographics
NPI:1255316410
Name:ELKINS, BRYANT K (MPT)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:K
Last Name:ELKINS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7977 VANN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8681
Mailing Address - Country:US
Mailing Address - Phone:812-568-0925
Mailing Address - Fax:502-371-6262
Practice Address - Street 1:7977 VANN RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8681
Practice Address - Country:US
Practice Address - Phone:812-568-0925
Practice Address - Fax:502-371-6262
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006980A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343141OtherBLUE CROSS BLUE SHIELD
IN200818610Medicaid
IN216070CMedicare ID - Type Unspecified
INP00142085Medicare UPIN
IN255480WMedicare PIN