Provider Demographics
NPI:1023381720
Name:ELLIOTT, ERIN G (LMT)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:G
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11455 CAMBRAY CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3925
Mailing Address - Country:US
Mailing Address - Phone:813-579-0717
Mailing Address - Fax:
Practice Address - Street 1:11455 CAMBRAY CREEK LOOP
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3925
Practice Address - Country:US
Practice Address - Phone:813-579-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist