Provider Demographics
NPI:1205442126
Name:ELIA, JOHN ROSARIO (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROSARIO
Last Name:ELIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0725
Mailing Address - Country:US
Mailing Address - Phone:585-582-6273
Mailing Address - Fax:
Practice Address - Street 1:229 PARRISH ST STE 220
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty