Provider Demographics
NPI:1811163496
Name:KROTH, ELAINE M (PTA)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:KROTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33100 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:1-1
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1390
Mailing Address - Country:US
Mailing Address - Phone:440-695-4541
Mailing Address - Fax:440-695-4541
Practice Address - Street 1:33100 CLEVELAND CLINIC BLVD
Practice Address - Street 2:1-1
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1390
Practice Address - Country:US
Practice Address - Phone:440-695-4541
Practice Address - Fax:440-695-4198
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1946225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant