Provider Demographics
NPI:1982348132
Name:ELISES CORP
Entity Type:Organization
Organization Name:ELISES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELISES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:641-780-9068
Mailing Address - Street 1:1202 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1224
Mailing Address - Country:US
Mailing Address - Phone:641-780-9068
Mailing Address - Fax:
Practice Address - Street 1:611 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4278
Practice Address - Country:US
Practice Address - Phone:641-684-6571
Practice Address - Fax:642-683-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty