Provider Demographics
NPI:1063696334
Name:SEMEL, ELISA R (MPT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:R
Last Name:SEMEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11723 RIVERSIDE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4034
Mailing Address - Country:US
Mailing Address - Phone:818-970-1050
Mailing Address - Fax:
Practice Address - Street 1:11723 RIVERSIDE DR APT 4
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4034
Practice Address - Country:US
Practice Address - Phone:818-970-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist