Provider Demographics
NPI:1437402526
Name:ELLIOTT, PETER RYAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:RYAN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MEDICAL CENTER EAST SOUTH TOWER
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-406-5346
Mailing Address - Fax:
Practice Address - Street 1:3200 MEDICAL CENTER EAST SOUTH TOWER
Practice Address - Street 2:SUITE 3200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-406-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1592OtherTENNESSEE ATHLETIC TRAINER'S LICENSE