Provider Demographics
NPI:1336397447
Name:ELISCUPIDES, EDGARDO LAHER (RPT)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:LAHER
Last Name:ELISCUPIDES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 KESTREL STREET
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342
Mailing Address - Country:US
Mailing Address - Phone:219-947-1786
Mailing Address - Fax:
Practice Address - Street 1:7495 KESTREL ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6950
Practice Address - Country:US
Practice Address - Phone:219-947-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008511A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist