Provider Demographics
NPI:1659822583
Name:FRIEDEMAN, ELISABETH (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:FRIEDEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 SLATER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3328
Mailing Address - Country:US
Mailing Address - Phone:707-206-8325
Mailing Address - Fax:
Practice Address - Street 1:1121 SLATER ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3328
Practice Address - Country:US
Practice Address - Phone:707-206-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist