Provider Demographics
NPI:1891950002
Name:YATES HORTON, ELIZABETH A (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:YATES HORTON
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 1:103 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1709
Mailing Address - Country:US
Mailing Address - Phone:716-868-1114
Mailing Address - Fax:
Practice Address - Street 1:103 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1709
Practice Address - Country:US
Practice Address - Phone:716-868-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030509-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23424OtherMARYLAND BOARD OF PHYSICAL THERAPY
NY030509-1OtherNEW YORK STATE LICENSE NUMBER
DC871186OtherDC HEALTH LICENSING ADMINISTRATION