Provider Demographics
NPI:1437187275
Name:ELLIOTT, JAMES M (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
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Mailing Address - Street 1:1884 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4434
Mailing Address - Country:US
Mailing Address - Phone:720-304-6578
Mailing Address - Fax:
Practice Address - Street 1:3434 47TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1880
Practice Address - Country:US
Practice Address - Phone:303-449-7611
Practice Address - Fax:303-442-8786
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO6717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist