Provider Demographics
NPI:1962686246
Name:ELTING, MALLORY LORETTA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:LORETTA
Last Name:ELTING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 ROAD V
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:NE
Mailing Address - Zip Code:68961-8727
Mailing Address - Country:US
Mailing Address - Phone:402-984-9169
Mailing Address - Fax:
Practice Address - Street 1:3735 ROAD V
Practice Address - Street 2:
Practice Address - City:NELSON
Practice Address - State:NE
Practice Address - Zip Code:68961-8727
Practice Address - Country:US
Practice Address - Phone:402-984-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE816225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant