Provider Demographics
NPI:1467864330
Name:PENDLETON, ELISE COLEY (PTA)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:COLEY
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 31ST STREET DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7913
Mailing Address - Country:US
Mailing Address - Phone:828-244-4266
Mailing Address - Fax:
Practice Address - Street 1:2545 31ST STREET DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7913
Practice Address - Country:US
Practice Address - Phone:828-244-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPTA 4042225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant