Provider Demographics
NPI:1457408668
Name:ELSE, ANTHONY R (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:ELSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 WOODSMERE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4408
Mailing Address - Country:US
Mailing Address - Phone:321-757-0626
Mailing Address - Fax:321-757-0323
Practice Address - Street 1:1335 US HWY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4408
Practice Address - Country:US
Practice Address - Phone:321-757-0626
Practice Address - Fax:321-757-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist