Provider Demographics
NPI:1275841207
Name:ELLIOT, STEPHANIE ELAINE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2407
Mailing Address - Country:US
Mailing Address - Phone:502-807-2621
Mailing Address - Fax:
Practice Address - Street 1:1792 ALYSHEBA WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2288
Practice Address - Country:US
Practice Address - Phone:859-264-9249
Practice Address - Fax:859-264-0016
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist