Provider Demographics
NPI:1831265057
Name:ELMORE, ERIC MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MICHAEL
Last Name:ELMORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3602 E GREENWAY RD
Mailing Address - Street 2:#106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4648
Mailing Address - Country:US
Mailing Address - Phone:602-652-1112
Mailing Address - Fax:602-652-1114
Practice Address - Street 1:3602 E GREENWAY RD
Practice Address - Street 2:#106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-652-1112
Practice Address - Fax:602-652-1114
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ6034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116558Medicare PIN
AZZ116449Medicare PIN