Provider Demographics
NPI:1780045419
Name:ELMORE CENTER FOR PHYSICAL THERAPY AND LYMPHEDEMA SERVICES
Entity Type:Organization
Organization Name:ELMORE CENTER FOR PHYSICAL THERAPY AND LYMPHEDEMA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-885-9135
Mailing Address - Street 1:15 FLOWERING APRICOT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6362
Mailing Address - Country:US
Mailing Address - Phone:919-885-9135
Mailing Address - Fax:
Practice Address - Street 1:7417 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE#103
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8824
Practice Address - Country:US
Practice Address - Phone:919-217-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14582261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy