Provider Demographics
NPI:1639112709
Name:MORSE, ELLIOTT DRIGGS (PT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:DRIGGS
Last Name:MORSE
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 1:652 GRANGER RD
Mailing Address - Street 2:APT 1
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-5369
Mailing Address - Country:US
Mailing Address - Phone:802-223-4200
Mailing Address - Fax:
Practice Address - Street 1:84 SO MAIN STREET
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-476-3305
Practice Address - Fax:802-476-0976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2233Medicaid
VTVN2233Medicare ID - Type Unspecified