Provider Demographics
NPI:1295337186
Name:ROUTT, ELISABETH AGNETTA
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:AGNETTA
Last Name:ROUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28570 STONECROFT DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2750
Mailing Address - Country:US
Mailing Address - Phone:832-571-5760
Mailing Address - Fax:
Practice Address - Street 1:28570 STONECROFT DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2750
Practice Address - Country:US
Practice Address - Phone:832-571-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor