Provider Demographics
NPI:1184168411
Name:KRONTHAL, ELIZABETH NEILLE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NEILLE
Last Name:KRONTHAL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 HAMPSHIRE GRADE RD
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-7174
Mailing Address - Country:US
Mailing Address - Phone:240-506-3228
Mailing Address - Fax:
Practice Address - Street 1:50 MULBERRY TREE ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1274
Practice Address - Country:US
Practice Address - Phone:304-724-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 002185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant