Provider Demographics
NPI:1770936981
Name:ELDER, MARY FRANCES (LMT,RMA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:ELDER
Suffix:
Gender:F
Credentials:LMT,RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-3333
Mailing Address - Country:US
Mailing Address - Phone:419-984-5908
Mailing Address - Fax:419-872-3258
Practice Address - Street 1:28442 E RIVER RD STE 204205
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2795
Practice Address - Country:US
Practice Address - Phone:419-984-5908
Practice Address - Fax:419-872-3258
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023038173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist