Provider Demographics
NPI:1972547636
Name:DOUGLASS, ELISABETH MAY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:MAY
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ELISABETH
Other - Middle Name:MAY
Other - Last Name:GARWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2807 GREYSTONE COMM BLVD.
Mailing Address - Street 2:SUITE 34
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-745-3660
Mailing Address - Fax:205-408-4209
Practice Address - Street 1:85 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125
Practice Address - Country:US
Practice Address - Phone:205-338-6106
Practice Address - Fax:205-814-9180
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
73984Medicare UPIN
51527222Medicare ID - Type Unspecified