Provider Demographics
NPI:1265548549
Name:ELLIOTT, AMY NOELLE (LPTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NOELLE
Last Name:ELLIOTT
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 1:2917 ALAMOSA CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2413
Mailing Address - Country:US
Mailing Address - Phone:970-635-9507
Mailing Address - Fax:
Practice Address - Street 1:286 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2733
Practice Address - Country:US
Practice Address - Phone:970-663-3720
Practice Address - Fax:970-667-7682
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT972225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05030002Medicaid
CO00035030Medicare ID - Type Unspecified