Provider Demographics
NPI:1740900711
Name:STORIE, ELIZABETH GRACE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRACE
Last Name:STORIE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12458 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:RALPH
Mailing Address - State:AL
Mailing Address - Zip Code:35480-9103
Mailing Address - Country:US
Mailing Address - Phone:205-886-3832
Mailing Address - Fax:
Practice Address - Street 1:2901 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3665
Practice Address - Country:US
Practice Address - Phone:205-886-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2847207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine