Provider Demographics
NPI:1609389501
Name:INTERIAN, ELIZABEHT
Entity Type:Individual
Prefix:
First Name:ELIZABEHT
Middle Name:
Last Name:INTERIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N REO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1062
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:888-809-3583
Practice Address - Street 1:550 N REO ST STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1062
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:888-809-3583
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist