Provider Demographics
NPI:1386820207
Name:ELLIOTT, NATHAN KENNETH (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:KENNETH
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 ALTAMONT PL STE 101
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3039
Mailing Address - Country:US
Mailing Address - Phone:301-645-0013
Mailing Address - Fax:301-645-1183
Practice Address - Street 1:4225 ALTAMONT PL STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3039
Practice Address - Country:US
Practice Address - Phone:301-645-0013
Practice Address - Fax:301-645-1183
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist