Provider Demographics
NPI:1457967150
Name:ZEKANOVIC, ELISE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:ZEKANOVIC
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5448
Mailing Address - Country:US
Mailing Address - Phone:508-846-7906
Mailing Address - Fax:
Practice Address - Street 1:333 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-1801
Practice Address - Country:US
Practice Address - Phone:978-663-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist