Provider Demographics
NPI:1295834760
Name:ELDER, EDWARD J (MS, ATC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ELDER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18021 15TH AVE. NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3809
Mailing Address - Country:US
Mailing Address - Phone:206-362-5255
Mailing Address - Fax:206-362-5260
Practice Address - Street 1:18021 15TH AVE. NE
Practice Address - Street 2:SUITE 201
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3809
Practice Address - Country:US
Practice Address - Phone:206-362-5255
Practice Address - Fax:206-362-5260
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer