Provider Demographics
NPI:1346862307
Name:ELSIS, KEIRA BRYN (LMT; CA)
Entity Type:Individual
Prefix:
First Name:KEIRA
Middle Name:BRYN
Last Name:ELSIS
Suffix:
Gender:F
Credentials:LMT; CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 LOMA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2791
Mailing Address - Country:US
Mailing Address - Phone:772-341-7518
Mailing Address - Fax:
Practice Address - Street 1:1375 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3523
Practice Address - Country:US
Practice Address - Phone:541-683-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist