Provider Demographics
NPI:1437834868
Name:DEAN, ELAINE CECILIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CECILIA
Last Name:DEAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 ANNA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2114
Mailing Address - Country:US
Mailing Address - Phone:937-701-4591
Mailing Address - Fax:
Practice Address - Street 1:5757 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3102
Practice Address - Country:US
Practice Address - Phone:800-780-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist