Provider Demographics
NPI:1669253134
Name:EUSTIS, ELIZABETH (LMBT, RYT 200,)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EUSTIS
Suffix:
Gender:F
Credentials:LMBT, RYT 200,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 PINEY GREEN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4577
Mailing Address - Country:US
Mailing Address - Phone:910-378-3208
Mailing Address - Fax:
Practice Address - Street 1:1368 PINEY GREEN RD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-4577
Practice Address - Country:US
Practice Address - Phone:910-378-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist