Provider Demographics
NPI:1710254214
Name:ELLIOTT, DEANNA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW SINCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3363
Mailing Address - Country:US
Mailing Address - Phone:541-237-4136
Mailing Address - Fax:
Practice Address - Street 1:1550 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5531
Practice Address - Country:US
Practice Address - Phone:541-237-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1431225100000X
OR6702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist