Provider Demographics
NPI:1679770382
Name:ELSER, PETER RICHARD (MSPT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:RICHARD
Last Name:ELSER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:6161 KEMPSVILLE CIR STE 250
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3950
Practice Address - Country:US
Practice Address - Phone:757-965-4890
Practice Address - Fax:757-965-4893
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192967OtherBCBS (PHYSICAL THERAPY)
VA9748355OtherAETNA
VA247660OtherBCBS (PHYSICAL THERAPY)
VA1679770382Medicaid
VAP00709407OtherRAILROAD MEDICARE
VA019510T54Medicare PIN
VA192967OtherBCBS (PHYSICAL THERAPY)