Provider Demographics
NPI:1811940950
Name:ELTON, ANDREW T (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:ELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 GULF OF MEXICO DR
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-2070
Mailing Address - Country:US
Mailing Address - Phone:941-209-3999
Mailing Address - Fax:941-210-3235
Practice Address - Street 1:5370 GULF OF MEXICO DR
Practice Address - Street 2:SUITE 204A
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2070
Practice Address - Country:US
Practice Address - Phone:941-209-3999
Practice Address - Fax:941-210-3235
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8568225100000X
FLPT30911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01779609OtherMEDICARE RR
NC2503977CMedicare PIN
FLP01779609OtherMEDICARE RR