Provider Demographics
NPI:1295814168
Name:DRIBAN, ELISSA (PT OCS)
Entity Type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:
Last Name:DRIBAN
Suffix:
Gender:F
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:#1650
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-986-9100
Mailing Address - Fax:301-986-9101
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:#1650
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-986-9100
Practice Address - Fax:301-986-9101
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD16575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist