Provider Demographics
NPI:1649480989
Name:ELROD, PAULA KAY (LPT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:ELROD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:75 EMERALD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8420
Mailing Address - Country:US
Mailing Address - Phone:432-550-7777
Mailing Address - Fax:432-550-8333
Practice Address - Street 1:1514 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3029
Practice Address - Country:US
Practice Address - Phone:432-550-8777
Practice Address - Fax:432-550-8333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456835Medicare ID - Type Unspecified