Provider Demographics
NPI:1417932765
Name:PINE, ELIZABETH HEATHER (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HEATHER
Last Name:PINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1007 GENEVA CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4003
Mailing Address - Country:US
Mailing Address - Phone:916-941-2334
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-7040
Practice Address - Fax:916-454-2703
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist