Provider Demographics
NPI:1508837196
Name:SALZMAN, ELYSE ROBIN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:ROBIN
Last Name:SALZMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:ROBIN
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1721 LAKEFIELD NORTH CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-1067
Mailing Address - Country:US
Mailing Address - Phone:954-579-1866
Mailing Address - Fax:
Practice Address - Street 1:1721 LAKEFIELD NORTH CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-1067
Practice Address - Country:US
Practice Address - Phone:954-579-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19238225100000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000976600Medicaid
FL886237100Medicaid