Provider Demographics
NPI:1598283970
Name:ETTER, ELIZA (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:ETTER
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5815
Mailing Address - Country:US
Mailing Address - Phone:301-782-2250
Mailing Address - Fax:
Practice Address - Street 1:156 WILLIAM ST RM 800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5347
Practice Address - Country:US
Practice Address - Phone:212-267-0240
Practice Address - Fax:866-928-4144
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01737200225100000X
MD27163225100000X
045071-1225100000X
NY045071-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist