Provider Demographics
NPI:1841638632
Name:FLOM, ELIZABETH MARIE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:FLOM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 UNTHANK ST.
Mailing Address - Street 2:#386
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-7676
Mailing Address - Country:US
Mailing Address - Phone:307-254-1462
Mailing Address - Fax:
Practice Address - Street 1:4810 UNTHANK AVE
Practice Address - Street 2:#386
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-7676
Practice Address - Country:US
Practice Address - Phone:307-254-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101783052255A2300X
WY0302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer