Provider Demographics
NPI:1417492489
Name:THOMAS, ELITTA (PTA26445)
Entity Type:Individual
Prefix:
First Name:ELITTA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA26445
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 NW CULEBRA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3683
Mailing Address - Country:US
Mailing Address - Phone:305-753-7270
Mailing Address - Fax:
Practice Address - Street 1:5952 NW CULEBRA AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3683
Practice Address - Country:US
Practice Address - Phone:305-753-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26445225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant