Provider Demographics
NPI:1689728420
Name:WOIDKE, ELAINE F (PT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:F
Last Name:WOIDKE
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 1:2435 W PAMPA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7851
Mailing Address - Country:US
Mailing Address - Phone:480-201-5275
Mailing Address - Fax:480-897-0014
Practice Address - Street 1:215 W LODGE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3652
Practice Address - Country:US
Practice Address - Phone:480-730-4103
Practice Address - Fax:480-897-0014
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist