Provider Demographics
NPI:1356627509
Name:YORK, ELISE (AAS, BS, LMT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:AAS, BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 BRIE TERRACE
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503
Mailing Address - Country:US
Mailing Address - Phone:541-788-2610
Mailing Address - Fax:
Practice Address - Street 1:924 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7025
Practice Address - Country:US
Practice Address - Phone:541-788-2610
Practice Address - Fax:541-236-1729
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14499225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist