Provider Demographics
NPI:1336743475
Name:STROM, ELI (MED, ATC)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:STROM
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 CROSBY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7801 N TIGERVILLE RD
Practice Address - Street 2:
Practice Address - City:TIGERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29688-9700
Practice Address - Country:US
Practice Address - Phone:360-610-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC5203572081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine