Provider Demographics
NPI:1316381817
Name:ELMORE, CAROL ELAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELAINE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JACARANDA CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7052
Mailing Address - Country:US
Mailing Address - Phone:678-697-6536
Mailing Address - Fax:
Practice Address - Street 1:540 JACARANDA CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7052
Practice Address - Country:US
Practice Address - Phone:678-697-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist