Provider Demographics
NPI:1689073348
Name:ELDREDGE, ELNATHAN
Entity Type:Individual
Prefix:
First Name:ELNATHAN
Middle Name:
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 NE VANCOUVER MALL DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6172
Mailing Address - Country:US
Mailing Address - Phone:360-256-9827
Mailing Address - Fax:
Practice Address - Street 1:9430 NE VANCOUVER MALL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6172
Practice Address - Country:US
Practice Address - Phone:360-256-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist