Provider Demographics
NPI:1770211740
Name:LIN, ELIANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIANA
Other - Middle Name:
Other - Last Name:SIRKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:22180 PONTIAC TRAIL
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9097
Mailing Address - Country:US
Mailing Address - Phone:248-446-0155
Mailing Address - Fax:248-446-0177
Practice Address - Street 1:22180 PONTIAC TRAIL
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9097
Practice Address - Country:US
Practice Address - Phone:248-446-0155
Practice Address - Fax:248-446-0177
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist