Provider Demographics
NPI:1891469177
Name:BIRD, ELISABETH ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANNE
Last Name:BIRD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 PEARL ST APT 147
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-3326
Mailing Address - Country:US
Mailing Address - Phone:913-707-9241
Mailing Address - Fax:
Practice Address - Street 1:2807 PEARL ST APT 147
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-3326
Practice Address - Country:US
Practice Address - Phone:913-707-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer