Provider Demographics
NPI:1639641996
Name:BOLLES, ELANOR (PT)
Entity Type:Individual
Prefix:
First Name:ELANOR
Middle Name:
Last Name:BOLLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W COUNTY LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5250
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:
Practice Address - Street 1:1411 W COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5250
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013006A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist