Provider Demographics
NPI:1417053711
Name:ATCHINSON, ELIZABETH DEJARNETTE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DEJARNETTE
Last Name:ATCHINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 LAGUNITAS RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7538
Mailing Address - Country:US
Mailing Address - Phone:505-379-3841
Mailing Address - Fax:
Practice Address - Street 1:2113 GOLF COURSE RD SE
Practice Address - Street 2:STE 106
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1656
Practice Address - Country:US
Practice Address - Phone:505-898-9700
Practice Address - Fax:505-898-8539
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2313OtherLICENSE #