Provider Demographics
NPI:1063244168
Name:ADELPHIN, ELISA (PT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:ADELPHIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 HIGH POINT AVE
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1928
Mailing Address - Country:US
Mailing Address - Phone:954-594-3779
Mailing Address - Fax:
Practice Address - Street 1:6166 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2540
Practice Address - Country:US
Practice Address - Phone:703-719-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216642225100000X
TX1403536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist