Provider Demographics
NPI:1922521806
Name:PERMAR, ELIZABETH M (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:PERMAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2282 SE GENOA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7335
Mailing Address - Country:US
Mailing Address - Phone:772-631-7518
Mailing Address - Fax:
Practice Address - Street 1:2282 SE GENOA ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7335
Practice Address - Country:US
Practice Address - Phone:772-631-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist