Provider Demographics
NPI:1275747016
Name:ELSAS, PHILIP (ITDS CERTIFIED)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:ELSAS
Suffix:
Gender:M
Credentials:ITDS CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101-1 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5318
Mailing Address - Country:US
Mailing Address - Phone:904-387-0370
Mailing Address - Fax:904-387-0156
Practice Address - Street 1:4101-1 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5318
Practice Address - Country:US
Practice Address - Phone:904-387-0370
Practice Address - Fax:904-387-0156
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist