Provider Demographics
NPI:1689628414
Name:ELSASSER, DAVID J (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ELSASSER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41125 N DAISY MOUNTAIN DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4954
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:623-551-5078
Practice Address - Street 1:9784 W YEARLING RD
Practice Address - Street 2:BLDG B, SUITE 1520
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1379
Practice Address - Country:US
Practice Address - Phone:623-412-2117
Practice Address - Fax:623-412-2118
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215006Medicaid
AZ215006Medicaid