Provider Demographics
NPI:1558357251
Name:ELIESON, PAUL SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:SCOTT
Last Name:ELIESON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2244
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-2244
Mailing Address - Country:US
Mailing Address - Phone:435-438-1214
Mailing Address - Fax:435-438-5482
Practice Address - Street 1:85 N. 400 E.
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-2244
Practice Address - Country:US
Practice Address - Phone:435-438-1214
Practice Address - Fax:435-438-5482
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120210-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP1311Medicare UPIN