Provider Demographics
NPI:1952406860
Name:CROSS, ELIZABETH SHEA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHEA
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771290
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1290
Mailing Address - Country:US
Mailing Address - Phone:901-202-6116
Mailing Address - Fax:901-202-8546
Practice Address - Street 1:1458 W POPLAR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0630
Practice Address - Country:US
Practice Address - Phone:901-850-1150
Practice Address - Fax:901-850-1102
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist