Provider Demographics
NPI:1841064557
Name:FOURNIER, ELYSE D (DPT)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:D
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MADISON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0600
Mailing Address - Country:US
Mailing Address - Phone:916-965-8900
Mailing Address - Fax:916-853-0259
Practice Address - Street 1:6601 MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0600
Practice Address - Country:US
Practice Address - Phone:916-965-8900
Practice Address - Fax:916-853-0259
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist