Provider Demographics
NPI:1760116586
Name:STUART, ELISE AVERI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:AVERI
Last Name:STUART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N OAK STREET EXT APT 508
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7620
Mailing Address - Country:US
Mailing Address - Phone:850-582-9080
Mailing Address - Fax:
Practice Address - Street 1:4900 TILLMAN XING
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-4108
Practice Address - Country:US
Practice Address - Phone:229-251-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist