Provider Demographics
NPI:1518121193
Name:ST. JOHN, ELIZABETH MINER (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MINER
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ALICE
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:144 METAIRIE LAWN DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5449
Mailing Address - Country:US
Mailing Address - Phone:504-615-1029
Mailing Address - Fax:
Practice Address - Street 1:144 METAIRIE LAWN DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5449
Practice Address - Country:US
Practice Address - Phone:504-615-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175918208100000X
LA07431R2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation