Provider Demographics
NPI:1497126726
Name:TARRANT, ELISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TARRANT
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 1:1860 EL CAMINO REAL 420
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3117
Mailing Address - Country:US
Mailing Address - Phone:650-652-2376
Mailing Address - Fax:650-652-9097
Practice Address - Street 1:126 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3625
Practice Address - Country:US
Practice Address - Phone:415-302-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist