Provider Demographics
NPI:1134862410
Name:KATIARELAS, ELIZABETH LAYNE (PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAYNE
Last Name:KATIARELAS
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 1:901 CALLE AMANECER
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-366-6785
Mailing Address - Fax:949-366-6785
Practice Address - Street 1:901 CALLE AMANECER
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-366-6785
Practice Address - Fax:949-366-6470
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant