Provider Demographics
NPI:1306009527
Name:GROSS, ELYSE F (PT)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:F
Last Name:GROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:F
Other - Last Name:STINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2775 SCHOENERSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-861-0854
Practice Address - Street 1:2775 SCHOENERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-861-0854
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
157280Medicare PIN