Provider Demographics
NPI:1457929358
Name:SHULMAN, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SHULMAN
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 1:505 CITY SPRINGS RD APT 12
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0141
Mailing Address - Country:US
Mailing Address - Phone:585-354-0028
Mailing Address - Fax:
Practice Address - Street 1:505 CITY SPRINGS RD APT 12
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0141
Practice Address - Country:US
Practice Address - Phone:585-354-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009645-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant