Provider Demographics
NPI:1689832792
Name:GOLOB, ELIDA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIDA
Middle Name:
Last Name:GOLOB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ELIDA
Other - Middle Name:OLSEN
Other - Last Name:GOLOB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:E. 220 MOHR ST
Mailing Address - City:PALOUSE
Mailing Address - State:WA
Mailing Address - Zip Code:99161-0357
Mailing Address - Country:US
Mailing Address - Phone:509-878-1495
Mailing Address - Fax:
Practice Address - Street 1:1150 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-9580
Practice Address - Country:US
Practice Address - Phone:509-397-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000031082251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00003108OtherPHYSIACL THERAPY
WA22OtherPHYSICAL THERAPY