Provider Demographics
NPI:1013276294
Name:ALDRIDGE, ELIZABETH A (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N SHORE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6383
Mailing Address - Country:US
Mailing Address - Phone:601-829-0505
Mailing Address - Fax:601-829-0506
Practice Address - Street 1:7213 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-829-0505
Practice Address - Fax:601-829-0506
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist