Provider Demographics
NPI:1568571172
Name:ROSENCRUM, ELISABETH CORLISS (PHD NHLAT ATC CSCS)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CORLISS
Last Name:ROSENCRUM
Suffix:
Gender:F
Credentials:PHD NHLAT ATC CSCS
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:CORLISS
Other - Last Name:MACRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LAT, ATC, CSCS
Mailing Address - Street 1:17 HIGH STREET
Mailing Address - Street 2:MSC 22
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-7845
Mailing Address - Country:US
Mailing Address - Phone:603-535-2577
Mailing Address - Fax:
Practice Address - Street 1:MSC 22
Practice Address - Street 2:17 HIGH STREET
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1595
Practice Address - Country:US
Practice Address - Phone:603-535-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer