Provider Demographics
NPI:1922255686
Name:ELAM, STEPHEN WAYNE (MPT, CLT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:ELAM
Suffix:
Gender:M
Credentials:MPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 MARSHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5505
Mailing Address - Country:US
Mailing Address - Phone:561-965-4376
Mailing Address - Fax:561-965-5696
Practice Address - Street 1:8045 MARSHWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5505
Practice Address - Country:US
Practice Address - Phone:561-965-4376
Practice Address - Fax:561-965-5696
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist